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@allaneparker I'm guessing the "insurance fraud" contract was either a misunderstanding with contractual obligations with in-network insurance or just a lie to get her to go away. But to answer your question, aside from doctors performing an initial evaluation in an emergency room setting...

@mavep24 Urgent care centers are intended for problems that can't wait until you can get an appointment with your regular clinic in three weeks, not problems that can't wait until morning. So as you're finding out they're not open 24 hours, or often even late on a weekend Saturday. A lot of the...

@wnnipooh At least in my state we've had that rule for the 20 years I've been in the industry. Possible someone just brought it to his attention and told him he'd better knock it off immediately.

@wnnipooh I think it's more it's illegal and that the doctor could get into huge trouble if he accepts cash payment from patients he knows have Medicaid as opposed to you getting you kicked off , but yeah, the idea is the same- the intent of Medicaid is for people that are so poor that they...

@destinite Cob Types vary. Under the most common type (hard-non-dupe) the secondary processes the claim agnostic of the primary, reduces it's payment by any payment made by the primary, and you are responsible for the lesser of two cost sharing amounts. In your case with out-of-network...

@foreverthankful Did they specifically state "We will pay the entire amount to charge" or "We will cover the procedure at this provider". I'm guessing the latter, and OP will need to eat the amount above the allowed amount because they made the choice to go to an out-of-network provider. Unless...

@defiant1968 You live in a country that doesn't have personal computers to enter patient data into, or doesn't keep track of what medications are given to patients in the hospital?

@dither Did you at one time have a commercial policy under your parents? If this is referring to "G & H Administrators" it's a secondary commercial policy some smaller employers buy to supplement a boilerplate primary policy that they buy. If that's the case G & H should have terminated you at...

@johm In my state there's no registraion or licensing for e-bikes (or regular bicycles for that matter).

@resjudicata You can use "balance billing" in colloquial, general sense, but it has a very specific meaning legally and with insurance, so it's best to stick with that when talking about insurance. The very specific meaning is the difference between the billed charge and the allowed amount for...

@resjudicata This is not balance billing. The original total on the claim is $15.008.30, and insurance paid $5,220.00 If this were balance billing there would be no discount applied and the OP would owe $9788 instead of $6788.30. This is not out of network, otherwise there would be balance...

@ronmstark I'm confused because you say the hospital is not in-network, but they're taking a $3008.30 write-off like they are in-network. Is "Savings Tier" maybe some sort of extended network? And I take it your deductible is over $7000 for that tier? The idea behind tiers is to try to direct...

@holl We can't answer that question because we don't know your plan design. None of the self-insured plans my company offers do, but some large self-insured plans do. Or have it cross-apply in both directions.

@theophan What does the EOB show you owe? If it was a coding issue it's possible it was denied as provider liability and the burden is on the providers to fix their boo-boo if they want to get paid.

@redcrambler Doesn't matter how well researched and well presented the information is. People's willingness to pay for information on the internet is essentially zero.

@downtherabbithole No, you didn't. Except for a couple of specific scenarios that don't apply to elective care, for out-of-network services the amount that gets applied to cost sharing is the insurance company allowed amount, and the amount you owe is the full billed amount. For example, on...

@principiatheologica The first question is kind of a gray area that's dependent on the scenario and open to interpretation and is one of the issues that periodically comes up here. It's one thing to fall and break your leg skateboarding and need immediate surgery as a compound fracture is...