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View Diary: Do You REALLY Want To Know How F-Ed Up Health Insurance Is ? (50 comments)

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  •  Explanation of Benefits (5+ / 0-)

    is probably what you are looking at (ha, "explanation" indeed). As in a previous comment, the doctor (hospital) puts in an initial retail charge for its service $3324, I assume). However, when the insurance company looks at the bill (claim) they will mark down that charge to the negotiated charge ($572.47) for that service between the doctor and the insurance company. YOU ARE NOT RESPONSIBLE FOR THE DIFFERENCE: it never existed in the first place. The total amount that the doctor would get from you and the insurance company COMBINED would be $572.47.

    Here is where your deductible is applied: the insurance company keeps a running total of all the charges that go towards your deductible, and you can call them and get that from them. If you had already exceeded the deductible, the insurance company would pay all of the $572.47 and you have to pay ZERO. Otherwise, you have to pay part or all of the $572.47 depending on where your running total of deductibles is before this charge.

    Obviously, looking at the EOB directly would help interpret all this even better.

    Well? Shall we go? At least that man is gone.

    by whenwego on Sat Feb 21, 2009 at 12:19:55 PM PST

    •  The EOB kicks me back to the codes. It (0+ / 0-)

      explains nothing.

      You just explained more than they did. That's how much it sucks. Not saying your explanation sucks , but that you explained more than they do.

      They only have me paying about $1588 on that $3000 when I have already paid more than that out of pocket. My problem is that they are using codes designed to keep me from reaching that $3000.00 marker.

      "I don't know it all, but I know that what I do know , I know enough of it to know that I know , I know it. Ya know ?" ~ Being In The Know

      by WeBetterWinThisTime on Sat Feb 21, 2009 at 12:24:54 PM PST

      [ Parent ]

      •  Key question here is: (5+ / 0-)

        Have you written checks adding up to $3000 to various providers this year? If so, you would have to pay ZERO for the rest of the year's treatment. If they try to dick you by showing a treatment as optional, immediately WRITE to them saying your doctor said it was NOT optional, and if you attach a letter from your doctor, that would be even better. If they still deny it, call the State Insurance Commissioner's office and ask for help.

        Well? Shall we go? At least that man is gone.

        by whenwego on Sat Feb 21, 2009 at 12:35:59 PM PST

        [ Parent ]

        •  Yes. I have. And I will take your advice. (1+ / 0-)
          Recommended by:
          mijita

          Thank you.

          I knew something was fishy. Thank you so much. That's what I wanted to know.

          "I don't know it all, but I know that what I do know , I know enough of it to know that I know , I know it. Ya know ?" ~ Being In The Know

          by WeBetterWinThisTime on Sat Feb 21, 2009 at 12:54:28 PM PST

          [ Parent ]

          •  it's a contest (1+ / 0-)
            Recommended by:
            WeBetterWinThisTime

            to see who will give up first, you, the hospital, or the insurance company.

            Send 'em back copies of all the bills you've paid, cancelled checks, whatever paper you have, showing that you've already paid $3000 out of pocket, and ask them to show you why they expect you to keep paying more.

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