Health Insurance benefit that cannot be accessed easily?
I commute 1.5I hours to work (I work 12 hour shifts to cut down on communting time). All the health care plans offered by my job (that 50%/$1600. is deducted from my paycheck annually for) have particiapting healthcare facilities local to my job and if I seek care near my home, it is called out of service and I must pay a higher percentage of a non-negociated rate. Also my local hosptial does balance billing so in actuality the money recieved from my insurance plan is just a bonus to my hospital in addition to what I must pay out of pocket. I.E my son's appendix was rupturing and he had surgery- he has a four inch scar from the open surgery. My insurance stated they pay 70% of their negociated rate of $3000.00 that included a 24 hour stay. My insurance company paid $2100.00. My hospital stated they charge $6800.00 for this service, they deducted the $2100.00 and demanded I pay $4700.00. I did pay it, but I am confused as to way I pay for health insurance that I cannot use to the fullest potential, and how can my insurance company determine a negociated rate that does not apply to the balance I must pay? (In other words, they don't really pay 70%, and my hospital won't state a rate for a simple appy so no matter what my insurance pays, it seems that they will charge me what ever they can get out of me.) Am I looking at this wrong, missing something here, or is my insurance company and local hospital both cheating me?
Asked By: ?????? - 9/15/2008
Best Answer - Chosen by Asker
I think some of the other people who have answered your question were confused, because you called the $3,000 a "negotiated rate." Based on the fact that you specifically stated that your local hospital is not participating with your insurer, I'm guessing that you meant that the $3,000 was your insurer's "usual and... More
Answered By: sarah314 - 9/16/2008
Additional Answers (4)
Something seems rotten here... More
Answered By: Wendy S - 9/15/2008
~~What the hospital did is illegal. They aren't allowed to balance bill the patient if they have a negotiated rate. You need to contact your insurance company an get their assistance in helping you to have the hospital refund you the difference you paid. If you don't get help, contact your state's insurance... More
Answered By: debijs - 9/15/2008
The hospital is correct. If you are out of network they can balance bill. The insurance company does not have a negotiated rate with out of network hospitals but apparently your policy states it will only pay 70% the negotiated rate whether you are in or out of network and you are responsible for the balance. This is... More
Answered By: Zarnev - 9/15/2008
If your son't condition was a true emergency (and a ruptured appendix would be one), does your plan then allow you to use an out of network hospital and get paid at an in-network rate? That might be something you could check in to.
Answered By: Lori S - 9/16/2008
Over 483 Local Jobs Now Hiring In Your Area. $18-$87/Hr - Apply Today!
Legitimate Survey for Cash.Extra Money for You,Join Here!
Shop Online or Sign Up To Sell AVON & Earn Fast Cash Today!
$21/hr Start, Avg Pay $72K/yr No Experience Needed! Get Started.
Other Career Questions
Do most mechanical engineering jobs offer job security?
What is your current job? Why did you choose this job? What do you enjoy about your job? What do you dislike about your job? What would be your perfect job? Would you rather have this j...
Where are the jobs? Is productivity and globalization creating a permanent “recession” of jobs? My main issue is I am doing a paper for school and have no idea where to begin. I was hoping suggestions...
Content is not owned or controlled by Monster. Any content concerns should be addressed with Yahoo!
Yahoo! Does not evaluate or guarantee the accuracy of any Yahoo! Answers content. Yahoo! Disclaimer.
Best-Paying Work-from-Home Jobs
It’s easier than ever to work from home. Of course, not every job is a mobile job, and some companies aren’t interested in having their employees work from home.
2013 Marketing Jobs Outlook
The US may be facing another year of anemic hiring overall, but that won't be the case in the high-orbit world of multichannel, digital media marketing.
2013 Engineering Jobs Outlook
Engineers will find job opportunities in select disciplines in 2013, with candidates who are all-around, client-oriented businesspeople in demand.
Best-Paying Jobs by Major
What could you earn with a particular four-year degree? Find out by checking out this list of the top-paying jobs for 20 of the most common majors.
Eight High-Paying, Secure Jobs
Want to earn a good salary and enjoy a measure of job security as well? Check out these well-paying jobs on tap for fast growth in the coming years.