I recently was hospitalized for 3 days and 2 nights. I met my deductible and my OOP max for the year prior to even being admitted. I just got slapped with a $1,300 bill from that stay strictly from the 25% coinsurance policy. Is this right? I’ve never dealt with a coinsurance fee before. Now I’m wondering what the point of even hitting the deductible or the OOP max is if I still have to pay 25% of the bill anyway? Is there anything I can do? I’m having a baby in 2ish weeks so now I’m freaking out about how absurd that bill is going to be now too….
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Do you have your EOB from your insurance? What does it say?
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What do you mean by “about what specifically”? I read my EOB, and it says that coinsurance costs start after I meet my deductible. If I’ve already hit my out-of-pocket maximum, why am I still paying thousands of dollars? What’s the point?
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Does the EOB state that you owe $1,300, or is that amount on the bill from the provider? Does it indicate that any services were denied? You’re correct that you shouldn’t owe more than your out-of-pocket maximum, assuming the services weren’t denied. Is it possible that the claims causing you to reach your out-of-pocket maximum haven’t been processed yet?
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The $1,300 is the bill from the provider, and no, it doesn’t say that any services were denied. Regarding the claims that caused me to hit the out-of-pocket maximum, I’m starting to think they processed them out of order. My hospital stay may be what pushed me over the max. The first time I read it, it indicated that I had already hit it, but when I check the dates of service, they’re not in order.
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So, you need to focus on the process date.
Check the EOB for this $1,300 claim. Does it list a possible patient responsibility?
Call your insurance and ask when the claim was processed and whether it was processed at the in-network (INN) rate or the out-of-network (OON) rate.
If this is an inpatient-related claim (like lab work, a physician, imaging, etc.), and the facility is in-network, they should also be able to process the specialist as in-network.
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Have you met your out-of-pocket maximum with bills that have already gone through the EOB process? Or are you thinking you’ve met it because of a hospital stay, but you haven’t received that bill yet? I’m asking because it doesn’t go in chronological order.
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Yes, I looked through my charges for the entire year and it stated I already hit both deductible and OOP max prior to my hospital stay and the $1300 bill is strictly from the hospital stay.
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Give your insurance company a call and ask them, then. Once you hit your OOP, yes, as long as it’s in-network and a covered service it would be paid 100% by them.
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Confirm whether the coinsurance applies to specific services or providers that might not be covered fully under your plan.
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If you believe there’s an error, ask your insurance to review the charges and correct any mistakes.