MRI Insurance Bill Question

I’ve really had no major medical bill before, so I’m completely new as to how to inquire about this or if I would even get any relief from this bill. I have insurance through UPMC and all of my services were at a UPMC facility. Apologies for the long-windedness, I like to be thorough.

I recently injured my ankle – thought it was a sprain – and had a friend drive me to urgent care. I was there for a few hours, saw a provider, and was provided crutches to take home. A week or so later I was referred to a sports medicine specialist and got an MRI. It looks like I may need surgery but it’s not 100% (we’ll cross that bridge in 2021 I suppose). Details:

  • Insurance: UPMC Advantage Gold 900/25 Premium Network PPO; $900/$1,800 in/out-of-network deductibles; Coinsurance 10%;
  • Insurance schedule of benefits relevant to this issue: Urgent care copay, specialist visit copay: $70 in-network; Diagnostic services: 10% after deductible is met.

I got two EOBs related to this issue, and they say different things:

  • EOB 1 (dated 11/22/20): MRI at UPMC Mercy (took place on 11/09). Amount charged: $4,110.00, UPMC network discount: $3,587.96, deductible and amount I owe: $522.04. This EOB states that my in-network deductible that I paid for the year to this point is $689.39/$900.
  • EOB 2 (dated 11/29/20): Physician visit at UPMC Mercy for the MRI (took place on 11/09). Amount charged: $191.00, UPMC network discount: $102.00, deductible and amount I owe: $89. Then what’s weird is that this EOB states that (a week later) my in-network deductible is $853.48/$900 for the year.

On 12/07/2020, I got a bill from UPMC stating I owe $611.04, which is the combined costs above. However, it looks to me as though all services were provided in network and that I’ve almost met my deductible for 2020. I’ve heard elsewhere that as a rule of thumb, call and ask for an itemized list of costs before paying anything, and usually they will send you a revised bill with different detailed charges.

Strategy for next steps? Any help greatly appreciated.

submitted by /u/senty78
[link] [comments]
I’ve really had no major medical bill before, so I’m completely new as to how to inquire about this or if I would even get any relief from this bill. I have insurance through UPMC and all of my services were at a UPMC facility. Apologies for the long-windedness, I like to be thorough. I recently injured my ankle – thought it was a sprain – and had a friend drive me to urgent care. I was there for a few hours, saw a provider, and was provided crutches to take home. A week or so later I was referred to a sports medicine specialist and got an MRI. It looks like I may need surgery but it’s not 100% (we’ll cross that bridge in 2021 I suppose). Details:
Insurance: UPMC Advantage Gold 900/25 Premium Network PPO; $900/$1,800 in/out-of-network deductibles; Coinsurance 10%; Insurance schedule of benefits relevant to this issue: Urgent care copay, specialist visit copay: $70 in-network; Diagnostic services: 10% after deductible is met.
I got two EOBs related to this issue, and they say different things:
EOB 1 (dated 11/22/20): MRI at UPMC Mercy (took place on 11/09). Amount charged: $4,110.00, UPMC network discount: $3,587.96, deductible and amount I owe: $522.04. This EOB states that my in-network deductible that I paid for the year to this point is $689.39/$900. EOB 2 (dated 11/29/20): Physician visit at UPMC Mercy for the MRI (took place on 11/09). Amount charged: $191.00, UPMC network discount: $102.00, deductible and amount I owe: $89. Then what’s weird is that this EOB states that (a week later) my in-network deductible is $853.48/$900 for the year.
On 12/07/2020, I got a bill from UPMC stating I owe $611.04, which is the combined costs above. However, it looks to me as though all services were provided in network and that I’ve almost met my deductible for 2020. I’ve heard elsewhere that as a rule of thumb, call and ask for an itemized list of costs before paying anything, and usually they will send you a revised bill with different detailed charges. Strategy for next steps? Any help greatly appreciated.
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