Medicare Plan G but hospital charging balance

[Luvdogs]

I went to the ER plus one night observation a few weeks ago and just received my bill. It was 32K(!!) but the amount they say I still owe is $450.

I have Plan G (not the high deductible) and have already paid my deductible (I think it's about $226)

It's not an itemized bill, just one page so it doesn't show what they are still billing me for. I will request that if needed.

I'm going to call them and discuss but I shouldn't be charged anything, right?

Thanks!!

 

[Brat]

Request an itemized bill.

 

[MichaelB]

I went to the ER plus one night observation a few weeks ago and just received my bill. It was 32K(!!) but the amount they say I still owe is $450.

I have Plan G (not the high deductible) and have already paid my deductible (I think it's about $226)

It's not an itemized bill, just one page so it doesn't show what they are still billing me for. I will request that if needed.

I'm going to call them and discuss but I shouldn't be charged anything, right?

Thanks!!

Your Plan G insurer should send you an Explanation of Benefits, which details all the charges and reimbursements and indicates the exact amount of your financial responsibility. I wouldn’t pay anything until you’ve seen the EOB.

 

[CardsFan]

Your Plan G insurer should send you an Explanation of Benefits, which details all the charges and reimbursements and indicates the exact amount of your financial responsibility. I wouldn’t pay anything until you’ve seen the EOB.

+1

If you want to see something with more detail, log into your Medicare account.

Also, check your Plan G account to see if it was submitted to them. If not, call the hospital to get it submitted.

In any event, there is no way I would pay anything until you get a EOB from the Plan G provider.

 

[PaunchyPirate]

The above advice is all accurate. One thing you might owe would if the hospital did something that was not a covered Medicare treatment. Medicare would not pay for it and therefore your supplement would not either. Those are not typical, but not impossible.

 

[John Galt III]

The 'observation' word is a red flag. I don't think it is covered by Medicare.

 

[MBSC]

The 'observation' word is a red flag. I don't think it is covered by Medicare.

Outpatient observation is covered by Medicare. It's the Skilled Nursing Facility that is not covered if the patient was in observation status instead of the 3-day inpatient hospital stay.

Covered outpatient hospital services may include:

Emergency or observation services, which may include an overnight stay in the hospital or services in an outpatient clinic (including same-day surgery).

https://www.medicare.gov/coverage/outpatient-hospital-services

 

[Dash man]

+1

If you want to see something with more detail, log into your Medicare account.

Also, check your Plan G account to see if it was submitted to them. If not, call the hospital to get it submitted.

In any event, there is no way I would pay anything until you get a EOB from the Plan G provider.

The hospital does not submit charges to the Plan G provider. Medicare submits it after it pays, and if Medicare pays, the Plan G provider pays minus any deductible owed.
The OP should wait to get the EOB from both Medicare and his Plan G provider. If it’s not cleared up, contact the hospital to resubmit to Medicare.

 

[CardsFan]

The hospital does not submit charges to the Plan G provider. Medicare submits it after it pays, and if Medicare pays, the Plan G provider pays minus any deductible owed.
The OP should wait to get the EOB from both Medicare and his Plan G provider. If it’s not cleared up, contact the hospital to resubmit to Medicare.

Thanks for the info. I was not aware that is how it was done

 

[pacergal]

Ditto what folks say, wait for EOBs from your insurance companies.
You could also request an itemized bill, just for your review. It is a good idea. I have found things billed for that did not occur.

 

[RS53576GG]

I had a related problem where a hospital claimed I owned them $110 for something that had been paid by my supplemental Plan F policy over a year earlier. Their bill wasn't too clear about what the specific item the charge was for so I dug through my statements and found something that matched the amount they claimed I owed them. I called my Plan F policy company and reached someone who looked through their records and said that they had paid it. I told this person that the hospital thinks otherwise. The service rep said he'd call the hospital and get it straightened out. He called me back and said it's taken care of.

A couple months later I received the same bill for the same amount. I repeated the process and this time the hospital said I definitely owed them the money because their records showed it hadn't been paid. I called my Plan F insurance company and they were very helpful again. Gave me the date they received the bill, the date they paid it, what the check number was and a few other things. I got the name of the customer service person so the hospital could call if they wanted to. I contacted the hospital again and ended up talking to a supervisor and she said that their records definitely showed it hadn't been paid. I told her all the info that the insurance company had given me and that I had my Explanation of Benefits that showed it was paid. She gave me an email address to send a copy of the EOB to. I emailed the EOB and a summary of when payment was made, check number, etc and some additional info. That was enough for them to decide it had been paid after all. They never officially notified me but a couple days later I logged on their website and it said my account balance was now zero. The whole matter just disappeared. My guess is that they discovered that a new employee (or maybe just a dumb one) was hitting the wrong button on a menu while auditing their payment records.

Everyone at the hospital and the insurance company were nice to deal with and very helpful. It just took a little persistence to get the hospital to recognize that something had gone wrong on their end of things.

I always wonder how many people in similar situations would get tired dealing with everyone and just mail the hospital and check and leave it at that. The money wasn't all that much but it's a matter of principle. Why give in and support a flawed process that could adversely effect others?

 

[Dawg52]

I've received these before. When I know I have met my deductible I just write them a note explaining this and I usually never hear another word from them.