Insurance companies actually make money from higher hospital rates, counter-intuitively. Actually you might know this if you ever peered over your own parasitical accounting fiefdom. ... So "thank you" insurance for "negotiating" but I'll take it from here.You should receive and EOB from your insurance provider. It should show the CPT codes that were billed, the amount, the "allowed" amount, and what was paid (zero in this case). You are responsible for the "allowed" amounts. Your insurance company has already negotiated a rate for care provided to you. So, pay the amount that your insurance company says is your responsibility and move on.
If you have questions/concerns about what services were billed, then ask the provider and if the answer isn't clear, speak to your insurance company. Ultimately, it is a bill you will need to pay.
When a patient has had their questions fully answered by my financial office yet still don't want to pay the full amount but rather want to "negotiate", we just let them know that they can negotiate it with the collection agency to whom we will be sending the account.
Actually, if we're to believe things are above board, my further negotiation should be a boon for the Insurance company. That means less likelihood of claim payments from them as I'll exceed the deductible more slowly. They should be giving me kickbacks for my services rendered. You're welcome, Blue Cross!
Yes, I see the billing codes. The only shred of transparency is mandated by Federal and State Law. Without it, the opaque mess would be even more opaque. But like I said, the "prices" are made up & the points don't matter. .... And even if they did have some consistency (per menu item) to prevent .... say racial discrimination lawsuits ... they have WIDE latitude to upcode procedures behind medical gobbledygook -- at the discretion of a Doc or Tech who has direct financial incentive to upcode. They know 99% of patients wouldn't even begin to decipher this.
Nah, I think I'm good. If I have evidence I was overcharged based on standardized coding guidelines, my doctor friends, and comparable cash rates, I'll just file a small claims lawsuit in Illinois with my findings. Limit is $10,000, well over the bill -- I think filing cost $40.we just let them know that they can negotiate it with the collection agency
Hopefully I'll win. If I don't, I'll sit in amusement that the hospital's internal Legal Council probably ran them $250 an hour. And needless to say I'll skewer them on all the review websites.
Also I think a Hospital "CFO" giving advice on fighting Big Hospital is like Luke Skywalker getting advice from Emperor Palpatine. Thanks but no thanks ha.
Statistics: Posted by PeterParker — Mon Mar 18, 2024 10:23 pm — Replies 18 — Views 1103