I don't understand. I was in the hospital for a few days earlier this year and the bill was around $30,000.... Insurance payed everything except about $700, the hospital says I'm responsible for the balance. This was after I had already paid my deductible amount to my insurance company.

Why do I owe? I strictly remember not signing any form saying I'd be responsible for anything unpaid from the insurance company.

They are threatening to turn it over to a CA now, and it really bugs me that I'm expected to pay that amount...

What can I do? Do I really owe it?

Any advice would be appreciated.

Thanks! -Ninecount

It all depends.. is the hospital in network? What does the insurance EOB say? You say you paid your deductible to your insurance company? Normally your deductible to the provider......

have you called the insurance?

You need to read your EOB carefully and understand the terms correctly. Quite a few people don't understand the difference between the following terms:

Copayment: a set fee for your health plan may require you to pay your doctor or other health care provider at each visit for certain covered services. Usually routine visits to the physician, office visits, emergency care (usually the facility portion as medical services are often billed separately).

Coinsurance: the percentage of the cost you will pay for covered medical service, after your health plan has paid its portion. This is usually the coverage percentages you see with your plan - "in network" vs "out of network" commonly have different co-insurance requirements. As an example - I have a 10% co-insurance with my health plan in network, out of network, I have a 40% co-insurance requirement.

Deductible: a fixed amount your health plan may require you to pay for certain covered services and supplies each year before your plan starts paying specific benefits. Commonly copayments are not applied toward your annual deductible.

Most plans offer a maximum out-of-pocket benefit. This is a predetermined amount that the consumer pays each year (excluding co-pays commonly) before their health plan kicks in coverage at 100%. I have had health plans where this benefit is shared between in/out of network costs, and others where each has its own specific ceiling.

As an example:

My current plan is as follows (in and out of network providers share these amounts - not not all plans are like this):
Individual Deductible: $200.00 Out of Pocket Maximum: $1,200.00 Lifetime Maximum: $1 million
Family Deductible: $400.00 Out of Pocket Maximum: $3,600.00 (for DH and I its actually 2400 - max family is the amount stated - so if there were 4 in my family - we'd have to meet only 3.6k out of pocket).

Each year I have to meet the first 200 (the deductible) before I could get benefits paid by insurance. My husband has to meet his own 200 before insurance kicked in. Copays don't count.

THEN, I have to incur $1200 each year in out of pocket expsnses before the insurance will cover 100% of the cost. This amount is met through payment of my 200 deductible and any co-insurance I pay during the year. My plan then covers 100% of the allowable charges outside of the out of pocket max for both in and out of network, once my out of pocket maximum has been met for the remainder of the calendar year.

Note that some plans may have different ceilings for in network vs out of network. So, though you've met your deductible, you may have not met your out of pocket maximum ceiling OR if your ceilings aren't shared between the two, then you may have met all in network requirements, yet may have gone to an out-of network provider and haven't yet met out of pocket maximums there.

Different plans have different benefits and the number of benefits, or degree of coverage is dependent on cost. I don't know if employers have to meet minimum coverage requirements or not, but I do know that for what I spend (90/mo for me and DH) we get the most comprehensive coverage we've ever had insurance wise as well as much smaller co-pay, deductible, and co-insurance requirements. My sister pays 125 for herself/husband and has higher co-pays, different co-insurance rquirements for in/out of network, and a slightly higher out of pocket max, when her baby turns one she'll be paying 150/mo. My co employs over 1500 folks, where hers only employs 50 so affordability to the employer may also factor in what your get.

Well,

Let me clarify something.... I didn't mean to say I paid my deductible TO my insurance company, rather I've paid my deductible amount. Which was $300. I had a few small bills that I paid eventually getting to that $300 deductible amount... I did not pay the insurance company directly. Hope that clears that up.

Thanks for the advice, I'll get my detailed billing and contact my HR dept and Insurance company to see why the hospital thinks I owe them $700.