Gotta love health insurance company claims explanations

[Brian Elfert]

I had hernia surgery recently. My health insurance company just posted the explanation of the hospital's claim online today. One single line that just says "Surgical Services" and then shows a total for over $10,000. You would think for a $10,000 claim the explanation of what they paid for might be more than two words. I hope the hospital's bill is a bit more detailed.

I have to over $1,100 of the hospital bill myself. Between the hospital, surgeon, and others I'm on the hook for over $1,600 for this surgery.

[Michael Weber]

They are truly amazing to read. I'm always amazed at how much an insurance companies allowance for a procedure is compared to the original billed amount. Especially Medicare. Often pennies on the dollar. I don't know who is being billed for the full hospital charges but I do feel sorry for them.

[Gerry Grzadzinski]

I have to over $1,100 of the hospital bill myself. Between the hospital, surgeon, and others I'm on the hook for over $1,600 for this surgery.

As long as insurance companies are making profits on health care, patients will continue to pay more and more, at a rapidly increasing rate.
Many people that don't have employer provided health care pay $4000-$7000 per year in monthly premiums, and still have $5000 deductibles that need to be paid in cases like yours.

[Frederick Skelly]

They are truly amazing to read. I'm always amazed at how much an insurance companies allowance for a procedure is compared to the original billed amount. Especially Medicare. Often pennies on the dollar. I don't know who is being billed for the full hospital charges but I do feel sorry for them.

In some doctor offices, hospitals and even ERs, you sign paper that clearly says you will pay what the insurance doesnt. I once had to pay several hundred $$ extra after an ER visit. In other cases, I've often wondered if the doctor is able to write off the amount of what wasnt paid, as a loss against his taxes - because I cant think of any other reason for the large difference Mike mentions. I dont know - Ive just always wondered.

[Jerome Stanek]

My wife went to the hospital back in 96 and we didn't have insurance her bill was almost half of what they tried to bill the insurance company and then dropped it more when we paid in cash. I did a line by line audit and found around $500 that they charged that for stuff that she never received and double billed for other stuff.

[Brian Elfert]

The bill was over $10,000, but the insurance company only paid about $6,500 of it and the hospital had to eat the rest. The contract between the providers and the insurance company says the provider cannot bill the patient for the remainder. I was at the hospital for exactly four hours from walking in to being wheeled out so they charged over $2,500 an hour for their services. Surgeon was a relative bargain at only $1350.

My main beef is still that the insurance provides zero detail about what they paid for other than surgical services.

[Wade Lippman]

Many people that don't have employer provided health care pay $4000-$7000 per year in monthly premiums, and still have $5000 deductibles that need to be paid in cases like yours.
Then they live in the wrong place. I pay $6,000 a year for a platinum plan with no deductibles and minimal copays. Go Obamacare!

I could actually have gotten it for $4,500, but would have had to change doctors and there was only emergency care out of region. I asked if getting sand in my eye would be paid for in Florida and they truthfully told me no. Seems like an emergency to me.

[Frederick Skelly]

Brian, Im missing something important here - why are you concerned about what the insurance paid, as long as you dont have to pay that part of it? Are you trying to make sure youre not being billed for something that insurance already covered, double checking them like Jerome did or something else?

Not trying to be a wise guy here. Im just not following you.
Fred

[Greg Peterson]

I've been trying to figure out, since the HMO debate, what role insurance has in the health care delivery model and how that role reduces cost to the consumer and improves efficiency and creates better health care results.

[Michael Weber]

Like Frederick mentions, there is likely a tax advantage or accounting reason for the large difference between the billed amounts and insurance allowable charges. A businessman once told me that hospitals love the big uncollectable bills. I just assumed he meant they can save as much or more with tax write offs than they would get from insurance company allowables. The country has certainly built an overly complex health care establishment with so many parties involved.

[Matt Meiser]

I had my gall bladder out last year at the hospital where my wife works. I have my own insurance but we use her flexible spending. Their flexible spending wouldn't accept their billings because there wasn't enough detail--said something very similar. My wife asked someone she knew to generate the detail and it was a small book.

[Kev Williams]

Don't worry, unless someone is asleep you WILL get a detailed bill..

Last March my wife had a subarachnoid brain hemorrhage, spent 13 days in the hospital, 11 of them in ICU.

First off we got the 'denied' paperwork. That's scary. Then a few days later we got the insurance company's version of the charges. It all fit on one page.
Even scarier than the denials: Grand Total: $107,000....

About a week later we got the bill for our share, which I was expecting well into 5 figures, starting with a "2" or a "3"...

I still don't believe it, but our end was less than $2000. And this was Medicare coverage provided by --*shall remain nameless*-- ...

It was about 6 weeks after the fact we got THEE bill from the hospital-- pages and pages of every pill, test, bag of saline, everything.

Brian, I'm sure you'll be getting yours soon. :) ( or maybe :( fits better )

[Joel Goodman]

The odd part of the whole process is that few, if anyone, pays the book rate. The insurance companies have a discount, the poor folks without insurance can't pay the bill -- so what's the point of billing a phantom number? I recently had a small procedure done -- the amount Blue Cross paid was about a tenth of the billed price. Try asking a car dealer for a 90% discount! I assume there is a reason for the imaginary book prices, but what is it? As a sidebar I have insurance through my union, who self insures, but pays Blue Cross to "administer" the hospital portion of the plan -- in fact what we get from Blue Cross are the discounted rates.

[Rich Engelhardt]

I hate this topic- - - health care.....

Every day I wake up alive, I feel more and more like some kind of cash crop the whole medical and insurance world is cultivating and at some point I'm going to have my life savings harvested.....

[Rick Moyer]

As long as insurance companies are making profits on health care, patients will continue to pay more and more, at a rapidly increasing rate.
Many people that don't have employer provided health care pay $4000-$7000 per year in monthly premiums, and still have $5000 deductibles that need to be paid in cases like yours.
yeah, or double that, but thanks for reminding me. Did I mention that I HATE insurance dictating everything.

[Keith Pitman]

As a 40 year veteran of the health insurance industry, I can tell you that hospital billed charges are pretty meaningless today--except for some situations where hospitals are paid on a percentage of billed charges. Usually hospitals are paid on a perdiem or a by diagnosis or by surgical procedure or some other type of flat rate. Thats why you don't see a detail on your explanation of benefits. Similarly finding $500 in erroneous charges on your bill is mostly irrelevant (unless the hospital is paid based on a percentage of billed charges, which is not the usual mechanism for the big companies). It would reduce public confusion to just stop displaying billed charges in all situations. As someone pointed out, if you don't have insurance, and you are billed for the list price, ask the hospital (or doctor) for their best price . . . Then ask if they can do a little better. You should get at least 40-50% off billed charges.

[Bill Orbine]

You might not get a detailed explanation on your Summary of Benefits (SOB) or Explanation of Benefits (EOB).... same as I get whether I look up online or on paper. The EOB/SOB's are just bottom line cost form each doctor,practice or institution. However, your insurance company might have another section online (their website) about the care you received. My insurance company calls it "personal health record" and it a little more detailed about the conditions and treatments I received without getting into the cost. Navigate your insurance website a little more and you might find something about the care you received.

[Bruce Wrenn]

My wife and I both have Medicare Advantage plans. Mine thru State Retirees plan, and hers through AARP. We both take Zetia. Her co-payment is over $40, while mine is $38. Here's the kicker. UHC says by having insurance they saved us over $220 on this prescription. They list it as costing $261 and some change. But, the first month I had mine filled, pharmacy didn't have me listed as having insurance, and the charge for prescription was only $58, not $261. Several years back when I was on a BCBS plan, one prescription had a co pay of $75. Pharm. told I should pay cash and forget insurance. He told me the cash price was $54, instead of a co pay of $75. When asked about co pay being more than retail price, he stated they sent the excess to insurance company, which means they pocketed $21 every time I used insurance. Always ask what cash price is!

[Brian Elfert]

I'm just wondering how an insurance company can consolidate a $10,000+ bill into a single line item? I assume I will get a bill from the hospital at some point. I'm not sure what good a detailed bill will do me because how will I know if there is something there that shouldn't be? It looks like I probably won't get the actual bill from the hospital until next month which is fine by me.

[Jerome Stanek]

As a 40 year veteran of the health insurance industry, I can tell you that hospital billed charges are pretty meaningless today--except for some situations where hospitals are paid on a percentage of billed charges. Usually hospitals are paid on a perdiem or a by diagnosis or by surgical procedure or some other type of flat rate. Thats why you don't see a detail on your explanation of benefits. Similarly finding $500 in erroneous charges on your bill is mostly irrelevant (unless the hospital is paid based on a percentage of billed charges, which is not the usual mechanism for the big companies). It would reduce public confusion to just stop displaying billed charges in all situations. As someone pointed out, if you don't have insurance, and you are billed for the list price, ask the hospital (or doctor) for their best price . . . Then ask if they can do a little better. You should get at least 40-50% off billed charges.

$500 was a lot when we were paying the bill also getting a 10% discount for cash was a good chunk of money

[Chris Damm]

I asked for an itemized bill For my daughter's surgery and all it did was make me more mad. It was 40 pages long and every aspirin was $10! Talk about overcharging, Heck the jar for a urine sample was $15 and another$3 for the lid. I wish I had that concession.

[Rich Engelhardt]

As someone pointed out, if you don't have insurance, and you are billed for the list price, ask the hospital (or doctor) for their best price . . . Then ask if they can do a little better. Tried that. I was told that since insurance was now required for everyone, there is no such thing as a price for uninsured.

[Jerome Stanek]

Tried that. I was told that since insurance was now required for everyone, there is no such thing as a price for uninsured.

Tell that to the millions of genxer's that don't have insurance. Some hospitals still give a discount for payment in cash