Medical Costs: What happens in this situation?

[Mermanaid]

The Children's hospital called a week or so before DD's MRI and told me that our share of the cost was going to be $412. She also told me that when she had spoke with the insurance company she saw we were close to meeting our annual out of pocket max (yippee!). The day of the procedure they also told me it was going to be $412 and asked for payment then and there.

I logged onto BCBS's site today and see the EOB that was processed. There are actually two of them. One of them for the MRI with anesthesia shows our share is $896 and then there is another EOB for the MRI procedure that shows $256.

The hospital had supposedly checked benefits and given me one amount and now I am seeing costs that are triple what we were told. I would not have withheld the care, but may have timed it a bit differently. Oh, and since when the hospital scheduled this they told me she would be given anesthesia I would have expected that would have been included in the original estimate.

Soooo, what happens in this situation?

[o_mom]

Radiology and anesthesiology are typically billed separately. When DS3 had a sedated MRI, we got three bills. One was from the hospital, one from the anesthesiologist and one from the radiologist. Most likely what you are seeing are those three bills coming through. The original 'estimate' from the hospital was likely only for hospital services.

Check with your hospital, but around here they all offer zero interest payment plans that are really easy to set up.

[Mermanaid]

Yeah, I figured we'd get a radiology bill (and I assume that is the $220 EOB; I mistyped $256!).

What is baffling to me is there is nothing on these EOBs that shows $412. Where the heck did that number come from?!

[BDKmom]

I would at least call the hospital billing department and ask them to explain it to you. Maybe something got filed wrong. They could have entered the wrong procedure code or something when they filed the claim.

I don't think you can hold them to the estimate they gave, as it is an estimate, and nothing is really known for sure until the claim is filed, but they should be able to work out some sort of payment option so that you don't have to send that amount all at once.

[o_mom]

Yeah, I figured we'd get a radiology bill (and I assume that is the $220 EOB; I mistyped $256!).

What is baffling to me is there is nothing on these EOBs that shows $412. Where the heck did that number come from?!

Really the only way to know is to call and talk to them. It's always an estimate until they actually do it. It's possible they pre-certified it without anesthesia and that is the increase.

I would expect to see one more bill from anesthesia as well (separate from the 'MRI w/anesthesia' one).

[kbud]

I would probably wait and see if they bill you anything additional. I've often seen differences from my insurance statement to what I get actually billed for by the provider.

[lalasmama]

I would probably wait and see if they bill you anything additional. I've often seen differences from my insurance statement to what I get actually billed for by the provider.

:yeahthat:

Also, remember it could change based on how close you are to meeting your annual out-of-pocket amount.

I'd expect 3 bills: (1) MRI itself (ie, the room, the machine), (2) the radiologist (for reading the images obtained), and (3) the anesthesiologist (for the sedation).

[crl]

I had a similar experience when ds was put under general for dental work at age three. I understood the dentist would bill separately and that happened exactly as I was told. But we weren't sure if insurance would cover the anesthesia at all and couldn't get an answer out of our insurance company. So I called the hospital and asked what the total would be for us assuming insurance would not cover it. I was told a number around $5000. About a month after the procedure we got a bill for over $20,000. I was furious and we were very anxious as we did not have the money to cover that at all at that point.

I called the hospital and ended up talking with an omsbudsman who was willing to see what she could do for us. I told her that if our insurance ended up covering it, that was fine, but if not, I wanted to talk about the hospital reducing the bill. Nothing unexpected happened during the procedure so there was no reason for the huge disparity. Insurance ended up covering it, thank God.

Good luck sorting yours out--maybe see if there is an omsbudsman.

Catherine

[Mermanaid]

Thanks, all. I spoke with the insurance co yesterday and per call notes the hospital was never told the $412 estimate so they must have estimated it themselves in some way. So the error has been identified.

The claim at BCBS closed on 8/13 so I'd imagine we will be getting a bill from the hospital in the next few weeks. I checked our acct at the hospital last night and it was still showing the $412 number. One can hope!

On another note, if this does go thru at the $89x rate we have officially met out out of pocket max for the year. Lol. That means my Mirena will be inserted at no cost as well as DD's supprelin surgery and follow ups.

[psimpson3-5]

I am VERY familiar with verifying insurance benefits as I used to do it for a job I had previously.

Please call the hospital and ask them to give you the procedure codes or CPT codes for any and all procedures that occurred at the hospital. Then you can call your insurance company and ask for the coverage for these CPT codes. Please note that insurance companies have a "contracted rate" with the hospital for ALL services. Therefore, the hospital usually bills for a TON more than the agreed upon price with the insurance company. The hospital cannot bill you for anything above the contracted rate. Also find out how much was left on your out of pocket maximum. You should never have to pay beyond that amount.

For instance - when I gave birth to DS, the hospital billed my insurance company for upwards of $18000. The contracted rate for birth was around $8000. I ended up paying for my deductible - $500, plus $200 per day I was in the hospital. Nothing more.