Help with an unfair medical bill please :(

[Taryn237]

My insurance was billed $6663 for my 20 week maternal fetal ultrasound.  The hospital is saying this was the correct amount.  We have a high deductible plan and my insurance allowed $5331 for the procedure.  They are saying we owe $3233.  They already paid the $2000 we had in our HRA account and 'we may owe' the other $1233.  This is insane for one 40 min standard ultrasound.  Does anyone know how to fight this?

[Taryn237]

Nevermind  :)  They are going to accept the $2093 from our insurance as the complete payment and will hold the $2000 from our HRA and apply to the bills from the delivery in April.  Thank God.

[Annie Mac]

Wow. I'm glad you got that sorted out. That's CRAZY! I sometimes tell myself we won't return to the U.S. to live until they've sorted out the mess that is the medical system. I once had identical procedures performed at two different hospitals. The 2nd one involved more staff, however the 1st hosp charged 8000+ and the 2nd charged 1500. What???

[Juvysen]

oh.my.god!  Our 20 week ultrasound at the hospital was $800 and I thought *that* was outrageous.  The ultrasounds at the OB I used to go to were only like $150.  Highway robbery.  I'm in shock. 

[diana_of_the_dunes]

Lucky you.  We had a similar situation a few years ago when DH had to get "fitted" with a neck brace.  An employee from the medical supply shop came over and decided whether he was a medium or large.  Then we got a $1200 bill for a "custom fit" neck brace that we found online for $125.  I was livid when we got the bill.  Thankfully, the hospital *graciously* decided to accept the $800 Anthem paid them. 

[hopefulfaith]

The important thing to remember is that if you have an insurance plan and see a preferred provider, that provider has already contractually agreed to accept a certain amount of payment from the insurance plan for each test/procedure, etc.  They can't balance bill you for the difference between what they're requesting and what they've already agreed to accept as payment.

[BetsyS]

Originally Posted by hopefulfaith 

The important thing to remember is that if you have an insurance plan and see a preferred provider, that provider has already contractually agreed to accept a certain amount of payment from the insurance plan for each test/procedure, etc.  They can't balance bill you for the difference between what they're requesting and what they've already agreed to accept as payment.

Yes, but this means that they can't bill for the difference between what they want ($6630), and what the insurance allows ($5331).  It has nothing to do with not being allowed to collect what is termed "patient's responsibility" (in this case, the difference between $2093 and the $5300). 

OP, I'm glad the hospital decided to work with you.  That's crazy rates that your hospital charged. 

[texmati]

I just wanted to add-- It's a pain in the neck, but for planned medical things it's possible to ask your insurance what the allowed rate is. I normally have to call the provider and find out what hte codes are, and then call my insurance company. It should be waaay more straightforward, but it's possible.