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
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