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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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  •  Without the whole EOB it's hard for me to tell (1+ / 0-)
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    WeBetterWinThisTime

    I think that they deemed one of the CT's not medically necessary.  While a physician may order a test (and in an ER that is not just based on diagnostics, but also on the standard of care), that does NOT mean the insurance company will deem it medically necessary.  

    In the ER this is especially true as physicians must order tests to be within the standard of care or face possible litigation.  I would wager that you would also have to have pre-authorization from your insurance company for CT's, MRI's and PET Scans as these are the high dollar tests that are sometimes ordered when x-rays will do.

    That would mean you are paying your deductible and coinsurance.  From what I can tell from  your post, you went to a network provider.  They are bound by contract not to charge you MORE than the contract allows, i.e. your deductible and coinsurance.

    If you had gone out of network, the insurance would have paid off of usual and customary charges, which the hospital is NOT obliged to accept as payment and you could be balance billed for any amounts the insurance didn't cover.  That isn't an issue in this case, but you may want to make sure which hospitals in your area are providers, as it is considered the patient's responsibilty to choose an in-network provider.

    Now for the bad news, you have two more bills coming at least.  One from the ER Physician and one from the Radiologist.  Their charges are usually not has high as the hospital's because of lower overhead, etc.  The good news is you've met your deductible, so you should owe either your coinsurance (which would apply to your out of pocket) or your copay (which does NOT apply to your out of pocket).

    I hope this helps, and I hope you are feeling MUCH better.

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