Re: ER Co-Pay for After Hours?

Kachina624 · ‎03-10-2010

@haddon9. Have you signed up for a Medicare supplement? If not, you may be in for an unpleasant surprise. Medicare is a wonderful thing.

New Mexico☀️Land Of Enchantment

lmt · ‎05-19-2010

@kittyloo wrote:
@lmt really sorry to hear about your story. Maybe you didn't read the op's post. she only paid $78 out of pocket.

@kittyloo I'm not sure who you're directing your comment to.

I'm the OP. I didn't just pay $78 for this hospital stay. So far I've paid over $600 out of pocket. None of my physical therapy has been added in yet.

My only complaint is for the co-pay of $78. I feel it's being penalized for using the emergency room after hours.

Where does it stop? What if I needed emergency surgery after hours? Would I be penalized for that too?

I wish I did only pay $78 total for my out of pocket expenses. I'd be thrilled!!

lmt · ‎05-19-2010

@Kachina624 wrote:
@haddon9. Have you signed up for a Medicare supplement? If not, you may be in for an unpleasant surprise. Medicare is a wonderful thing.

@Kachina624 I have years to go before I can sign up for Medicare.

Once I'm eligible I do plan on signing up.

Meowingkitty · ‎06-19-2010

@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.
**********************

Two months ago I fell and broke my right wrist in two places requiring surgery to put in pins and plates and the surgery bill alone was over $70,000. That didn’t include the anesthesiologist, brace, and whatever else they come up with. That also didn’t include the emergency room. Thank goodness I have good insurance.

orphan annie325 · ‎05-20-2010

My sister was admitted to hospital last week after falling and breaking her leg--above where she had a knee replacement. They wanted to admit her to rehab floor in hospital after the surgery because she also has cancer and is receiving chemo. Medicare will not pay for her chemo if she is an inpatient rehab. If they discharge her to a separate facility as inpatient, the chemo will then be paid. In the meantime, she is taking up a bed in surg unit while they are trying to figure out a loophole to keep her inhospital! Go figure.

haddon9 · ‎03-09-2010

@Kachina624 wrote:
@haddon9. Have you signed up for a Medicare supplement? If not, you may be in for an unpleasant surprise. Medicare is a wonderful thing.

@Kachina624 Yes I just did yesterday afternoon! My neighbor specializes in Medicare supplemental insurance and guided me through it.

nomless · ‎03-10-2010

@lmt wrote:
@kittyloo wrote:
@lmt really sorry to hear about your story. Maybe you didn't read the op's post. she only paid $78 out of pocket.

@kittyloo I'm not sure who you're directing your comment to.

I'm the OP. I didn't just pay $78 for this hospital stay. So far I've paid over $600 out of pocket. None of my physical therapy has been added in yet.

My only complaint is for the co-pay of $78. I feel it's being penalized for using the emergency room after hours.

Where does it stop? What if I needed emergency surgery after hours? Would I be penalized for that too?

I wish I did only pay $78 total for my out of pocket expenses. I'd be thrilled!!

@lmt

But the charge is legit, being based on the stated rules of your policy. It's just a rule you don't like. I don't see that as a reason to challenge the charge. The charge was not an error. You are asking for an exception to be made in yoyr case....for what reason? Why should the charge not apply to you when it applies to others in the same circumstance?

Writing a letter explaining why you don't like that rule and asking them to change it would be an appropriate action...it propably would have no effect, but it would be a reasonable respose to the charge that you don't like..

Still Raining · ‎03-30-2014

If they indicate a provider’s name, could be this be a doctor’s copay for being on-call? I assume an ortho came in for you.

Carmie · ‎10-25-2010

Your insurance company is the Federal Government. Blue Cross only processes claims for them as they are under contract to do so.

FEP insurance will waive the emergency room copay of $125 if you are admitted. An ER copay is for the hospital facility charges and does not include professional provider bills.

Doctors are not hospital employees. They have privileges to work in a hospital, but they provide their own services and do their own billing.

Because your FEP insurance plan does not cover shift differentials, your insurance correctly denied the extra charges for the evening hours. This is a pretty standard benefit for all FEP members as well as most other health insurance. Some insurance plans do not allow doctors to charge for this fee if they are in network. If that was the case in your situation, the EOB would state this.

The law states everyone can appeal any claim, but in your case, since shift differentials are excluded from your contract, it won't do any good. Blue Cross must process the claims according to the terms of your coverage. They cannot pay an excluded benefit upon an appeal or for any reason.

The Federal Government audits Insurance Companies monthly who process claims for their programs. If a claim is incorrectly processed, they will get fined. The fines are quite high...about $25k per error.

I wish I could tell you better news, but unfortunately, you are going to have to pony up for the shift differential bill.

The only way you can get out of paying this bill is to call the providers office and ask them to forgive the charges. They don't have to, but it doesn't cost anything to ask.

lmt · ‎05-19-2010

@nomless

Yes, the charge is legit. Yes, I don't like the rule. Yes, the charge is not an error.

The CS rep is the one who gave me the idea to file an appeal. I never even would've thought about doing that. She told me what I needed to do and even told me what page in the brochure to refer to. She said it can't hurt to try. So why shouldn't I?

I wrote a very succinct letter stating how unfair I thought this co-pay is. I don't feel it's fair to penalize anyone for receiving care "after hours". Do I think I'll actually get a refund? Not in a million years.

Maybe if more people weren't complacent and actually voiced their disapproval things might change.