A Weekend at the Hospital - Part II

Date 2005/5/22 4:14:57 | Topic: Links, Thoughts, and Open Thread

As you may have read in part I of this post, our son spent 3 days in the hospital recently because his Eczema became infected.

Though we haven't received any bills yet, we just received the Notice of Benefits from BlueCross BlueShield (BCBS) for his stay and treatment in the hospital:

Hospital Only Total: $10,006.32
Amount that BCBS claims we may owe: $1796.44

Of course we haven't received an itemized bill from the hospital yet. Not that we'll be able to understand it when it does arrive.

The funny thing with this is that because of the PPO agreement that the hospital has with BCBS, the hopital just sort of "waives" $6839.90 of that amount. Does that sink in? In other words, for instance the hospital charges $860.64 for "Laboratory". This amount exceeds the PPO negotiated amount by $663.57. Thus, the hospital will receive only $196.67.

Now, follow me here... Do you really think the hospital would negotiate a rate with the insurance company that would leave the hospital losing money, or failing to make a profit? Hell no!. On the charge of $196.67 above, the hospital has to be profiting by at least 10% - probably more. But yet, they charged $663.57? Why do you think that is? How screwed would one be without insurance?

One of the items listed on the Notice of Benefits that I'm looking at from BCBS is $1170.44 for "Op Accomodations", which was refused by the insurance company because "Your benefit plan only covers emergency care rendered within the specified time limit". What in sam hell does that mean? Can someone explain this to me?

I just get the feeling that over the next few months I'm going to be
- Broke
- Pissed off
- Learning how to appeal insurance decisions
- Learning how to audit and challenge medical bills

Wish me luck - we don't even know what the doctor bills and radiology bills are going to be...

This article comes from The Lewisville Texan Journal

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