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04-26-2019 10:05 PM
A few weeks ago I fell and broke my ankle. I was taken to the emergency room and admitted to the hospital for surgery.
While checking my claims online, I saw an EOB (explanaction of benefits) with a co-pay for $78. It only gives the providers name, date of service and the amount of the co-pay.
Since I had no idea what this claim was referring to I called CS (Federal Blue Cross) and was told the co-pay is for "medical service not covered through insurance". Not knowing what that meant, I asked for further information. The CS rep put me on hold to check and when she came back she stated that I have a co-pay for using the emergency room between the hours of 10pm - 8am.
I checked my benefit plan and it states that if you're admitted directly to the hospital they'll waive the usual emergency room co-pay, which is $125. It also states "emergency room professional charges for shift differentials" is not covered.
The CS rep told me I could file an appeal, which I plan on doing. I probably don't have a leg to stand on (pardon the pun) but I'll feel better at least trying.
As if we all don't pay enough with the price of insurance and co-pays. Now they (at least my insurance) is putting a charge on using the ER after hours!!
04-26-2019 10:10 PM - edited 04-26-2019 10:11 PM
My visit to the Er is $550.00 before they do anything to help or check me out...that's just going to the ER and giving them my name. However it will change as of May 1. I will finally be getting Medicare coverage!
Sorry to hear about your ankle! I wish you a full & speedy recovery!
04-26-2019 10:20 PM
@lmt wow! good for you for catching that!
OTOH, good luck trying to get your money back, or a direct/understandable answer.
i always picture that they have a big 3 ring binder in front of them, of how to answer specific questions. i hope you at least get a correct answer, or some money back.
at least you didn't have to pay that much out of pocket. i usually don't even read those. makes my head swim.
good luck.
04-26-2019 10:23 PM
I was curious after reading your post to see what I would have to pay in the event of a medical emergency. I logged onto my account and the charges are as follows: $10.00 co-pay for urgent care and $50.00 co-pay which will be waived if admitted for emergency care. I did not see where they will charge you a shift differential, but perhaps that's in the small print. (smile)
04-26-2019 10:26 PM
@haddon9 wrote:My visit to the Er is $550.00 before they do anything to help or check me out...that's just going to the ER and giving them my name. However it will change as of May 1. I will finally be getting Medicare coverage!
Sorry to hear about your ankle! I wish you a full & speedy recovery!
@haddon9 That amount is outrageous!
Thank you for your well wishes!!
04-26-2019 10:30 PM
@lmt wrote:
@haddon9 wrote:My visit to the Er is $550.00 before they do anything to help or check me out...that's just going to the ER and giving them my name. However it will change as of May 1. I will finally be getting Medicare coverage!
Sorry to hear about your ankle! I wish you a full & speedy recovery!
@haddon9 That amount is outrageous!
Thank you for your well wishes!!
@lmt You're welcome! . Keep your fingers crossed for me that I won't need to use the ER for the next several days! I can't wait to start Medicare!
04-26-2019 10:38 PM
@kittyloo wrote:@lmt wow! good for you for catching that!
OTOH, good luck trying to get your money back, or a direct/understandable answer.
i always picture that they have a big 3 ring binder in front of them, of how to answer specific questions. i hope you at least get a correct answer, or some money back.
at least you didn't have to pay that much out of pocket. i usually don't even read those. makes my head swim.
good luck.
@kittyloo I don't expect to get my money back, but I feel I have to try. Nothing ventured, nothing gained.
This ER after-hours-co-pay is just ONE of many. So far I have the hospital, the surgeon, durable equipment (a walker), the walking boot they fitted me for, home nursing visit, occupational therapy (at home) and physical therapy (at home). My co-pays so far are over $600. After I see the surgeon next month, I may need physical therapy in a professional place rather than at home.
The claims keep trickling in every few days. So far the total for my care is $71,888. For a broken ankle!
I can't imagine what people with really serious illnesses pay.
04-26-2019 10:42 PM
@icezeus wrote:I was curious after reading your post to see what I would have to pay in the event of a medical emergency. I logged onto my account and the charges are as follows: $10.00 co-pay for urgent care and $50.00 co-pay which will be waived if admitted for emergency care. I did not see where they will charge you a shift differential, but perhaps that's in the small print. (smile)
@icezeus You're lucky you have such low co-pays!!
Your insurance may not charge you for the shift differetial. Everyone's insurance is different.
I'm really not complaining about the other co-pays I have, but this one is really just appalling!!
04-26-2019 10:42 PM
@lmt really sorry to hear about your story. Maybe you didn't read the op's post. she only paid $78 out of pocket.
04-26-2019 10:45 PM
@lmt wrote:
@kittyloo wrote:@lmt wow! good for you for catching that!
OTOH, good luck trying to get your money back, or a direct/understandable answer.
i always picture that they have a big 3 ring binder in front of them, of how to answer specific questions. i hope you at least get a correct answer, or some money back.
at least you didn't have to pay that much out of pocket. i usually don't even read those. makes my head swim.
good luck.
@kittyloo I don't expect to get my money back, but I feel I have to try. Nothing ventured, nothing gained.
This ER after-hours-co-pay is just ONE of many. So far I have the hospital, the surgeon, durable equipment (a walker), the walking boot they fitted me for, home nursing visit, occupational therapy (at home) and physical therapy (at home). My co-pays so far are over $600. After I see the surgeon next month, I may need physical therapy in a professional place rather than at home.
The claims keep trickling in every few days. So far the total for my care is $71,888. For a broken ankle!
I can't imagine what people with really serious illnesses pay.
OMGosh....For a broken ankle no less.
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