Charged Twice for Hospital Visit?

[qzxcvbn]

I went to the hospital on 2/25.. my heart was racing, lightheaded, fell a couple times like half passing out (I am now diagnosed with type 2 diabetes). I wish I didn't as I am now realizing I didn't need it and preventative care is much cheaper. ANYWAY, I have NJ BCBS Omnia 1 and this was at an Atlantic Health hospital.. I have the following claims on my insurance exluding the ambulance bill ($200 after insurance):

1. Electrocardiogram Report , Billed $40, I owe $6.06 (finalized/paid)
2. Emergency Dept Visit, Billed $1109, I owe $433.50 (finalized/unpaid)
3. X-Ray Exam Chest 1 View , Billed $86 (pending claim/unpaid)
4. Billed $14,438.20 (pending claim/unpaid)
   1. Nfct Ds 22 Trgt Sars-Cov-2 $579.00
   2. X-Ray Exam Chest 1 View $1,294.00
   3. Emergency Dept Visit $9,310.00
   4. Electrocardiogram Tracing $1,242.00
   5. Glycosylated Hemoglobin Test $438.00
   6. Assay Of Troponin Quant $237.00
   7. Procalcitonin (Pct) $623.00
   8. Comprehen Metabolic Panel $364.00
   9. Routine Venipuncture $15.00

I stopped paying them as they came in once I saw the last one. Can someone tell me wtf is going on? The 3 biggest items on the huge bill were billed twice, with the separate ones being at much cheaper rates. Just including the first 3 and the ambulance, this will already be around $750 dollars for a ride to the hospital and 2 hours inside with a 'good' insurance plan. Is the double billing a genuine error? Can someone give me any sort of hope that I won't have to pay anything/that much on the 4th claim? Thanks for all your help.

 

[mthandeki]

@qzxcvbn You will be billed by both the Hospital and the Physician for some services. The ER visit has a hospital and physician component, so you will always see 2 bills here. Any diagnostic testing is billed by the hospital, but the interpretation fees are billed by the physician (X Rays and Labs).

Ignore any of the numbers until the claims are finalized. The amount charged by the hospital often has zero correlation with what your insurance will pay and what your out of pocket will be. Payers and providers use renegotiated contract rates for reimbursement 99.9% of the time.

Wait for your EOB and see what your out of pocket balance is.

 

[qzxcvbn]

@mthandeki I get that the EKG tracing and report are probably seperate. I’m more worried about the visit cost. I got a final bill for 433 but now there’s a second item for over 9,000 by the same name on the new bill. I’ll wait it all out before paying anything else.

 

[mthandeki]

@qzxcvbn At a minimum, wait until you confirm the remaining balance due on your EOB.

 

[mikethomas]

@qzxcvbn Er Dr bill and radiologist bill should be clearly different from the other bills. I admit it does look like they billed for 2 ER visits and 2 chest x-ray 1 views.
As others have said, wait for the EOB for everything and let the billing department try to sort out discrepancies before getting involved.

 

[aletia]

@qzxcvbn The large bill looks like the facility component, so basically the use of their building and equipment. The others are professional charges (ER Dr, radiologist, etc).

 

[foreverthankful]

@qzxcvbn It looks like Claims 1,2 and 3 are the "physician" bills- so The Electro, the ER visit and the X-ray--- paying the tech/nurse/doctor for their services

and the 4th bill is all of the care you got while at the ER- the ACTUAL X-ray, the ACTUAL Electrocardiogram---

It's not a duplication, it's just paying the hospital for using their equipment/supplies and then the doctor billing for their time. If you check your benefits contract/documents, you'll see benefits for hospital Physician and Hospital Facility fees.

But I agree that you should wait until you have an EOB from insurance that will tell you how much you really owe--- and you should only pay what the EOB says for in-network services.

But bottom line- an ER visit is expensive and tests/labs at the ER are going to be more expensive than getting the same at a PCP office lab or a stand-alone lab/imaging center.

And, if all of this was in-network, these amounts your paying will go towards your out of pocket maximum--- so whatever your OOPM dollar amount is, that's the most you'll pay in a year for all medically necessary, in-network, non-excluded care. You may hit that with this claim-- and then the rest of your care is covered for the rest of the plan year.

TLDR- it depends on what your EOBs say, if you stayed in network and what your OOPM is. If your OOPM is $6000, you've already paid about $500 with claim 1, 2 & 3 so the most you should have to pay of the 14K bill, assuming that it's not adjusted down further with the EOB is $5500.

Once you get that EOB, call the hospital and ask for a detailed bill-- more often than not, ER bills get smaller when you ask for an itemized invoice--- and from there, you can request a payment plan or charity care to help cover that cost. The amount the EOB says is the most the in-network doctor/ER can charge you, but it's possible they remove some of those charges when you request an itemized/detailed bill.

 

[qzxcvbn]

@foreverthankful Damn I could not afford $5500 rn lol thanks

 

[kgr13]

@qzxcvbn Wait until you receive your EOB for the new claims/billings and see what is covered and what insurance says is your share to pay

 

[blessedmom4]

@qzxcvbn Generally for er visits, you'll get a facility claim from the hospital itself, an er professional claim by the doctors who treated you, and a radiology claimby the radiologists who did any x-rays or other imaging services.