I had an HSG a few weeks ago. I asked the hospital for the information to find out the cost ahead of time. The gave me the procedure code, and told me to call my insurance. They told me there was a facility fee of $70, a doctor fee of $70, and possibly a fee to read the test, but that would be "$100 at the absolute most." The hospital called me and told me later that the cost would be $1050. I told them what the insurance said, and the woman said she would put a note in the chart. Today I got a bill for $1050. I looked at my insurance website, and it looks like the original bill was for $2600, the allowed amount was $1200, insurance paid $150, and I supposedly owe $1050. I looked up the Healthcare Bluebook fair cost of the procedure, which is $140 for my area. Has anyone else successfully gotten a charge decreased? I'm going to call them tomorrow, but what is the best way to talk to them to get the cost to be more in line with what I was told?
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@AmeliaBedilia: absolutely contest the amount. Tell them what the first person told you about it being $100 at most. Tell them the day and time you called and who you spoke to if possible. Everything is negotiable and charges are reduced all the time.
I was told by my doc office that my IUD was going to cost x dollars and I got a bill for a lot more. I called back explaining what happened and they honored what the person told me on it was going to cost
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@AmeliaBedilia: Oh, I just saw this. Call the insurance company and ask if that was supposed to happen. They will tell you. Your EOB should tell you what you may owe. Mine always says at the bottom "Information about amounts not covered. The amount billed is greater than the amount allowed for this service. Based on our agreement with this provider, you will not be billed the difference." If they charge you more than that, then it's balance billing, which is illegal and your insurance company should be able to help you take care of it.
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Yes, call back and talk to them! You can also ask the dr's office was code they used to bill it under. I've had a lot of issues with insurance for 2014 where I've had to call back and had something re-billed just to get it covered
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Deleted cause I totally read the issue wrong and this didn't make any sense at all.
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@PurplePumps: Allowed amount is the negotiated rate for the service. They allowed $1200 and paid $150, so the OP got a bill for the remainder- $1050.
@AmeliaBedilia: On your bill, is it the same procedure code that the hospital originally told you they would bill under? And when you said "They told me there was a facility fee of $70, a doctor fee of $70, and possibly a fee to read the test" was it the hospital that said that, or the insurance company?
If the hospital told you those things, or the procedure code is different, I would first start with the hospital billing department and complain to them. If the insurance company told you those numbers, then I would lodge a dispute, claiming they told you otherwise before the service.
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@ShootingStar: If that is the negotiated rate for the service, then she should not have gotten a bill for the remainder. The hospital can bill whatever they want, but their negotiated rate is the total amount that the hospital will end up collecting. So the way I'm reading it, the "allowed amount" can either mean what they insurance is willing to pay OR negotiated rate, which is why I asked for clarification on what exactly "allowed amount" means in this case.
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@PurplePumps: So the way it works is that her insurance has negotiated for that service code and they only *allow* the maximum charge of $1200. The insurance then paid $150, leaving $1050.
She didn't didn't get a bill for the remainder of the charge, she got a bill for the remainder of the allowed amount. If they hadn't had a negotiated/allowed rate, then the OP's bill would have been for $2450: $2600 (the full charge) - $150 (what ins paid).
Make sense?
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@ShootingStar: hahaha, oh yeah. I was totally reading that backwards. Oops. No wonder my math wasn't adding up.
Then isn't it up to what the insurance will cover? That should be pretty clear in the insurance policy. How did they come up with only paying $150 of that bill. -
@PurplePumps: Well it first depends on who told her what. If the hospital said "we will charge you $240 for doctor, facility and reading fees," but instead they charged $2600, then they messed up something. Either they quoted her wrong or they billed incorrectly. If the insurance company said "for x procedure code your responsibility is $240" then they didn't process the bill right, or they communicated incorrect information.
I re-read the original post and it looks like the insurance company said it would come to around $240 for the 3 fees. Assuming the hospital billed the procedure code they originally gave her, then her only recourse is to dispute with the insurance company.
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