Hi all,
Last month during the Covid surge I got sick and needed to get a couple PCR tests done. I decided to go to a drive through place, pay out of pocket, and submit the claim to my insurance company since I had the previous year with zero issue and was paid fully. All of the places that took insurance up front were booked out a week.
I submitted my claims and after about a month received checks in the mail. To my surprise, I was only reimbursed for a portion of the cost: $77. My EOBs read like this:
Amt billed: $175 Your discount “your plan negotiates with providers to save you money”: $98 Your plan paid: $77 You saved: $175
Now, obviously the negotiated discount doesn’t help me at all since I paid out of pocket! I called my insurance company about this and they told me I’d need to reach out to the test center and have them refund me this amount. Test center is saying they will not and that I need to talk to my insurance company.
I’m planning on calling my insurance company again today but before I do, does anyone have additional insight on situations like this? It’s ridiculous they present it like I’m paying nothing when they shorted me $98 on each claim. The year before they paid me the entire cost in full when I submitted my paid for upfront claim for reimbursement.
Am I screwed? Is this just a very expensive lesson?
Edit: another point is if they don’t end up reimbursing me for the remaining amount, shouldn’t this be added to my out of pocket max? Right not it is not.
submitted by /u/icecreamofficial
[link] [comments]Hi all, Last month during the Covid surge I got sick and needed to get a couple PCR tests done. I decided to go to a drive through place, pay out of pocket, and submit the claim to my insurance company since I had the previous year with zero issue and was paid fully. All of the places that took insurance up front were booked out a week. I submitted my claims and after about a month received checks in the mail. To my surprise, I was only reimbursed for a portion of the cost: $77. My EOBs read like this: Amt billed: $175 Your discount “your plan negotiates with providers to save you money”: $98 Your plan paid: $77 You saved: $175 Now, obviously the negotiated discount doesn’t help me at all since I paid out of pocket! I called my insurance company about this and they told me I’d need to reach out to the test center and have them refund me this amount. Test center is saying they will not and that I need to talk to my insurance company. I’m planning on calling my insurance company again today but before I do, does anyone have additional insight on situations like this? It’s ridiculous they present it like I’m paying nothing when they shorted me $98 on each claim. The year before they paid me the entire cost in full when I submitted my paid for upfront claim for reimbursement. Am I screwed? Is this just a very expensive lesson? Edit: another point is if they don’t end up reimbursing me for the remaining amount, shouldn’t this be added to my out of pocket max? Right not it is not. submitted by /u/icecreamofficial [link] [comments]Read Morer/HealthInsurance