Help me understand

nobody really

nobody really

I need a nap
So I had to be hospitalized several weeks ago taken by ambulance to cmh. Stayed overnight in the Hospital. So I get a bill from CMH for $4200 or so. My insurance paid all but $600. So I call them and ask why can't they accept what the insurance paid as payment in full? I have Aetna. So, she says, nope, that's your balance. Ok, I understand that. So how does this affordable health care act come in? I mean, if i was an illegal immigrant, or say, unemployed, how would the affordable health care act help? Would I not owe anything? If i did, how would i pay if i were unemployed or just couldn't?

So when i asked the girl on the phone this question, i heard crickets. I just don't understand if I have decent coverage, and still have to take it in the ass when i'm hospitalized, how is it supposed to help those who can't afford it? WTF, because I had Aetna i get the extra flower on my dinner tray when i'm hospitalized?

i just don't get it. How is affordable health care for everyone even a reality.
 
glhs837

glhs837

Power with Control
Ha, have you received a bill from the DR in the ER who treated you? Our last four E-room visits were by DRs who don't take our health care (although the hospital does) and bill separate)
 
Christy

Christy

b*tch rocket
You should probably call your insurance company and find out how to submit an appeal.

Health insurance is insane now. What was paid for last year is no longer covered, or health insurance companies will pay much less than what they used to. They negotiate new contracts with the providers every year and they don't bother to tell the consumer how that new contract and coverage will impact what they have to pay out of pocket.

I think the only thing the affordable healthcare act has done is benefit the insurance companies. They seem to be cutting their level of coverage to the bare minimum and charging the consumer much higher rates for less coverage. It's a bit mind boggling.
 
nobody really

nobody really

I need a nap
Christy said:
You should probably call your insurance company and find out how to submit an appeal.

Health insurance is insane now. What was paid for last year is no longer covered, or health insurance companies will pay much less than what they used to. They negotiate new contracts with the providers every year and they don't bother to tell the consumer how that new contract and coverage will impact what they have to pay out of pocket.

I think the only thing the affordable healthcare act has done is benefit the insurance companies. They seem to be cutting their level of coverage to the bare minimum and charging the consumer much higher rates for less coverage. It's a bit mind boggling.
Click to expand...

thanks Christy, i never thought about filing an appeal, i''ll give it a shot....but your right, rates have gone up, coverage is going down....
 
R

Rt235

New Member
Sorry for your CMH visit...But...get a detailed bill from CMH and see what your were charged for what and why! Everything coming into your room you get billed for..
Wife was in for a few days and it was shocking how many billing errors were made! Take some time and go over your charges...you may save some more $$$ that way!
And yes, ER is a "Private Contract" deal... Hope you are doing better!
 
T

tommyjo

New Member
beachcat said:
So I had to be hospitalized several weeks ago taken by ambulance to cmh. Stayed overnight in the Hospital. So I get a bill from CMH for $4200 or so. My insurance paid all but $600. So I call them and ask why can't they accept what the insurance paid as payment in full? I have Aetna. So, she says, nope, that's your balance. Ok, I understand that. So how does this affordable health care act come in? I mean, if i was an illegal immigrant, or say, unemployed, how would the affordable health care act help? Would I not owe anything? If i did, how would i pay if i were unemployed or just couldn't?

So when i asked the girl on the phone this question, i heard crickets. I just don't understand if I have decent coverage, and still have to take it in the ass when i'm hospitalized, how is it supposed to help those who can't afford it? WTF, because I had Aetna i get the extra flower on my dinner tray when i'm hospitalized?

i just don't get it. How is affordable health care for everyone even a reality.
Click to expand...

Having health insurance, even under the ACA, in no way means everything is paid for by the insurance. You still have deductibles and copays.
 
T

Tigerlily

Luvin Life !!!
beachcat said:
thanks Christy, i never thought about filing an appeal, i''ll give it a shot....but your right, rates have gone up, coverage is going down....
Click to expand...


Okay as someone who worked in the health insurance industry for 17 years, I can tell you that many factors may come into play regarding your visit and your bill. Most people have an annual deductible, so if you have not met your annual deductible that will come out first. Second were you admitted to the hospital once you were in the ER? If so they may be charging you an impatient copay many of which are a few hundred dollars. If you were not admitted then you may very well be charged for a ER copay because you did not use your regular physician. Many companies charge this if you are not injured or admitted. Add to this that many companies do not pay 100% until you have paid a certain amount annually out of pocket. Also keep in mind the bill you have (UB-92) is a facility bill. It will include the drawing of labs and items used in the hospital. Keep in mind that any professional fees ( IE: doctors visits, lab and x-ray interpretations will be billed separately on a (HCFA-1500) and are processed and paid separately as professional fees. You may also have your annual deductible and copays due on these as well. Also the ambulance bill will most likely be separate unless they charged it on your hospital bill. One more thing. Hopefully only in-network providers were used as the amount of coinsurance do can jump drastically from an in-net provider to a non participating one. Read your EOB's carefully. Also keep in mind that if you used an in-network facility and doctor that does not mean the labs or x-ray companies are in your network. You can always appeal to have them paid at the in-network rate as you have no control over what company is going to provide these services for you.
 
nobody really

nobody really

I need a nap
I know, I don't have a problem paying what i was billed for -- its just crazy the amount they charge, and all this talk about "affordable health care" is just crazy, i can't imagine if i was stuggling financially or even unemployed, what people would do. Its just crazy. I mean, CMH is excellent, don't get me wrong, but all this talk about giving illegal immigrants and people who don't want to work access to health care, is just mind boggling.
 
acommondisaster

acommondisaster

Active Member
Your deductible is probably somewhere between 2k and 6k. And now that we're paying for more people who don't pay into the system, the price of everything health related will go up. Just wait until you find out that a prescription that you have been taking for years is no longer covered by insurance. It's happening; best to get an HSA to help cover what comes out of pocket. The other bit of advice I have is always call your insurance company when you're thinking about going to the ER; it can mean a difference in price if you do.
 
MarieB

MarieB

New Member
glhs837 said:
Ha, have you received a bill from the DR in the ER who treated you? Our last four E-room visits were by DRs who don't take our health care (although the hospital does) and bill separate)
Click to expand...


I hope you disputed that. It's my understanding that if the hospital is a preferred provider ie in network then they have to cover the doc or the doc has to accept their amount.

We went through that with L&D and anesthesiologists.
 
MarieB

MarieB

New Member
As for the OP, there isn't enough information to go on. Normally there is a contractual price that the insurance company arranges with the provider, and you would have to cover any deductibles and copays.

I had to take my son to the ER about a month ago. I received 3 separate bills for that visit - hospital, radiologist, and physician. It came out to about $450. We are on a high deductible plan, so that is what we pay. The last trip to the ER was about $600
 
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