Insurance Eligible Charge

[reylene]

I had mid fossa surgery done by Dr. Slattery & Dr. Scwartz of HEI at St. Vincent's and the hospital bill was for $84,000.  My insurance says EC is $15,400.  They paid 80% of EC only.  That leave me with about $70,000.  Is that was all insurance companies use for their EC?  Summerlin Health & Life has been a big problem!  Surgery done 10/2/08 and this is the first payment received 1/16/09.  They give me a different answer to the same question every time I call.  I asked for a supervisor 3 times and she was not available, I left messages twice w/rep and once on her voicemail and she not once returned my call.  Any suggestions or info on EC determinations would be great!!

[Brendalu]

reylene,
What does your explanation of benefits say?  Usually if the hospital and docs were in your network they have a contract and accept whatever the amount paid by the insurance company.  You are only responsible for the deductible.  I would call and ask if the hospital is willing to accept the insurance company's payment if they aren't in network, lots of hospitals do.  I hope this helps.  Good luck.
Brenda

[reylene]

My insurance company is screwed up!! Today they tell me that St. Vincent's Medical Center is participating provider and they need to pay what they sent to me to St. Vincent's so I need to send money back.  They sent me one check for multiple claims not just for St. Vincent's.  It tooks more than 90 days for payment (1st payment only) and now they want money back.  Maybe I should make them wait just as long.....

[Pooter]

Perhaps you're asking the wrong person.  Ask the people at the hospital who did the bill to begin with.  They should be able to explain the bill better than the insurance reps.  I would expect the insurance company to pay more than 80% of "EC".

Regards,
Brian