Question
My wife gave birth at a birthing center in July. The hospital bill was initially ~$2,500. My insurance company paid ~$8,000. My coinsurance is 20%. The hospital now says I owe ~$1,700 which is on par with 20% of the overpayment. I have contacted both the hospital and the insurance company. They claim this is due to the contracted rate being higher than the bill and I am responsible for 20% of the contracted rate. I have two questions: 1. Is the $1,700 my responsibility and 2. what grounds do I have to fight this?
Answer
Hi Kyle!
I am assuming the insurance company paid $800 not $8000 as you state in your e-mail.
I think you need to view your explanation of benefits to see what is up. Did you have a prior authorization and was it needed? Was the hospital an in network provider?
Not really sure what you mean about the contracted rate being higher than the bill.......usually contracts are lower not higher.
I think your best bet would to call your insurance company and see what is going on. Ask for an explanation of benefits if you don't have one already. I think perhaps the hospital is asking for more than they should get.
Good Luck!
Tricia
