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Respected Contributor
Posts: 3,388
Registered: ‎05-19-2010

ER Co-Pay for After Hours?

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!!

 

 

Esteemed Contributor
Posts: 6,057
Registered: ‎03-09-2010

Re: ER Co-Pay for After Hours?

[ Edited ]

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!

Trusted Contributor
Posts: 1,784
Registered: ‎03-11-2010

Re: ER Co-Pay for After Hours?

@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.

Respected Contributor
Posts: 3,244
Registered: ‎10-30-2010

Re: ER Co-Pay for After Hours?

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)

Respected Contributor
Posts: 3,388
Registered: ‎05-19-2010

Re: ER Co-Pay for After Hours?


@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!! 

Esteemed Contributor
Posts: 6,057
Registered: ‎03-09-2010

Re: ER Co-Pay for After Hours?


@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! Smiley Happy . 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!

Respected Contributor
Posts: 3,388
Registered: ‎05-19-2010

Re: ER Co-Pay for After Hours?


@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.

Respected Contributor
Posts: 3,388
Registered: ‎05-19-2010

Re: ER Co-Pay for After Hours?


@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!!

Trusted Contributor
Posts: 1,784
Registered: ‎03-11-2010

Re: ER Co-Pay for After Hours?

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

 

Respected Contributor
Posts: 3,244
Registered: ‎10-30-2010

Re: ER Co-Pay for After Hours?


@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.


@kittyloo 

OMGosh....For a broken ankle no less.