NJres

This was for routine outpatient surgery (not mine). In at 10 am, 1/2 hr procedure with general anesthetic, 2 hour recovery, discharged and taken home around 3pm. Everything went well, no indication of any problems. Surgeon fee was separate, $700.

Insurance pays 90%, so $70 paid up front to cover 10% of surgeon fee, and right before procedure $670 was paid to cover 10% of the estimated fees of the surgical center. Friday afternoon we get the "this is not a bill" statement with one number on it, $11,700!! Of course, too late to call anyone. So instead of paying $670, our share will be $1,170.

Will start research Monday. First thing I want to see is an itemized bill... but... holy crap!

The care and treatment were fine. It's just the cost vs estimate.

SteveMA

Your estimate probably included the discounted rate they have with your insurance company. That isn't usually reflected on the bill. The bill will be for the full rate sent over to the insurance company then they will apply the discounted rate and you will get an explanation of benefits reflecting that and your final out of pocket cost. I wouldn't worry about it until you see the EOB.

blueiguana

I'm sure you've thought of this, but is it possible this is a difference between what the actual charges are and what the Usual & Customary Charges are that the insurance company will cover that the surgical center/Dr. will write off once it goes through insurance?

edit: crossed posts with Steve. He does a better job of explaining it, but this is where I was headed.

NJres

No I didn't think of that. Thanks! I will take a deep breath and wait until Monday. My only thought so far was wondering if the insurance company was actually going to pay that $11,700 amount. Seems they should be more concerned with the amount vs estimate than I am! It is also extremely annoying to get a "statement" with only one number on it.

sylvan8798

Don't pay any extra on it until the insurance company has completely taken care of their part of the bill. It can be difficult or impossible to get overpayments credited back to you.

ECmotherx2

Did the bill reflect the $670 paid the day of surgery? The bill usually states estimated cost of insurance reimbursement and estimated balance. If the statement that you received does not reflect this, it is just a preliminary statement. However, if it indicates the payment, be prepared to ask if they will deduct 10% of the balance if you send a check within the billing cycle. I always negotiate balances on medical bills.

CountingDown

When I had my defibrillator put in, the doc's bill was $7500 -- insurance negotiated rate was $2400. Don't freak yet. There is a big difference between retail and wholesale rates.

saintfan

You will get the paperwork from the insurance company eventually that says "billed amount $11,700 - allowable amount $6,700 - payment received $670 - amount due $0.

NJres

Thank you all. I feel much better now. The statement received said "This is not a bill" and only had one number on it, $11,700. I now expect it will play out the way saintfan (and others) described.

Proud Mary

As others said, relax . . . you'll probably end up paying nothing more.

I had major surgery several years ago. Total cost: $150,000. Insurance paid $90,000. I was billed $450. Best $450 I've ever spent!!

JustaMom5465

I win the prize. H had some unexpected major surgery this year. In looking up his YTD claims, the total "Billed amount" is $273,125.16. Paid Amount (reflecting the contracted amount with all providers) is $115,381.77. Our out of pocket costs...probably about $100.00. Right now, I love my insurance company. (I can't believe I just said that)

HImom

Yea, it can be pretty confusing. I was billed & paid > $800 for a test when I received a bill. Later, I called the hospital & asked why the bill was so much higher than usual, since my portion was usually under $50. They were surprised and asked if that meant I wanted a refund & re-credited my credit card over $800, so that my portion was as usual < $50. Be calmly persistent and get an itemization & wait for ALL insurance payments to be applied, as well as the deposit you already paid. Medical billing is VERY confusing.

jym626

If a doctor is in network with an insurance company they have to collect the full copay/coinsurance from you. Otherwise it can be seen as insurance fraud. If, for example a Dr charges $100 but insurance only allows $50 and you are responsible for 20% of the allowable, then you have to pay $10. If you only pay $5, then the insu co is in essence paying 90% rather than 80% of the allowable. Thats in violation of the contract between the insu and the Dr.

nj2011mom

My neighbor had a heart attack last year, but with CPR & the AED he was revived, however he spent 4 weeks in ICU due to lung issues from aspiration. Then a few weeks of rehab. Total bill was $1.5 million. I think they paid $100 deductible.

jym626

Maybe they had 2 insurances and the second picked up the balance.