Question:
Insurance paid versus contracted amount...

Man, ol' man. Talk about nerve-racking. I received a form letter from my insurance company yesterday afternoon about my hospital bill. It shows a total of $25,681.37 and they were only paying $4543.42! I wigged out- thats $19,231.37 that they were NOT paying. (My insurance is 70/30.) That amount was under "not eligible". HUH??? On the back it read that I owed $1906.58 and continued to say "If the hospital has billed more than $1906.58, you are not obligated to pay the difference." Of course PL&A are not open 24 hours so I would have to wait til this morning to call. I was told that the CONTRACTED amount between PL&A and CHS is $6450.00. They can not charge the insurance company or me anymore than that. So I said "So, the hospital is just going to eat $19,000???" And the reply was "yes". I asked what if they come after me for the 19k and she says they can't. It is a legally binding contract and they already know this and won't come after me for it- only the $1900. I am floored. This is just too good to be true. FOR ANYONE WHO HAS BEEN THROUGH THIS OR WORKS IN THE INSURANCE BUSINESS (or just knows about this), Can the hospital bill me for that 19k??? I am so worried about this that it is making me sick......    — karmiausnic (posted on October 29, 2002)

October 29, 2002
It's pretty shocking, isn't it? But it's true! My insurance contracted to pay only 6 grand of an 18 grand bill. If they were to try and bill me for it, my insurance's contract protects me. And they aren't trying to collect. Just sent me a bill for the $400 I owe them as my co-pay.
   — [Deactivated Member]

October 29, 2002
Your insurance company is correct. They can not charge the hospital or you more than the contracted amount. You don't need to worry. I know it seems impossible, but this is how HMOs work. They contract with hospitals and doctors for well under their standard fee. In return the hospitals get more business. The fees that they charge the insurance company are more in line with what it actually costs them to provide the service. Pay the $1906 and you will be fine. If they do send you a bill for more than that, contact your insurance company and let them help you fix it.
   — Amber L.

October 29, 2002
I work in the insurance business. And yes, contracted amount means that there is a contract between the hospital and the insurance company for a set dollar amount for a certain procedure or number of days inpatient. Just like when you go to the doctor..they have the same contracted amounts. This is VERY common. Almost never does a patient get billed the remainder and if they do, its usually an accident. Even if they do....its illegal because they are contractually obligated to write that portion off.....youre safe. : ) My bill came to 45,000. and they were only paid 4000. I owed my 100. and went about my day.
   — RebeccaP

October 29, 2002
hi i know this sounds odd to you but this is true i am a medical biller as as long as the hosiptal has a contract with the insurance company that is how it is they eat it dont worry you are safe rosemary
   — ROSEMARY A.

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