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Linda
Brandwin, R.N.
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Linda
Brandwin
is a registered nurse and a medical billing
and claims specialist. For the past 10 years
she has worked directly with insurance companies
to give advice and guidance to the health care
consumer.
Readers may send email
or write Linda Brandwin at 5500 Single Oak Hill
Ct., Woodbridge, VA 22192.
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Insurance
companies don't always write-off the difference on a
bill
Mar. 5, 2004
Q: I
had testing done at a local hospital and my insurance
company was billed $3700. They paid $1000 and the hospital
billed me the remainder. I called the billing department
to ask why I was responsible for the difference. The
insurance company had paid them the reasonable amount
allowed and I thought they should write off the difference.
Their reply was that they don't write off the difference.
I owe it. Was this correct?
A:
It could be correct. If the hospital does not participate
with your insurance plan, then there is no write-off.
The insurance pays whatever amount they allow and you
are responsible for the remaining amount.
If
the hospital does participate with your insurance plan,
then there may be a write-off. Your explanation of benefits
that you receive from your insurance company should
tell you what your responsibility is. If you do not
have your EOB, call your insurance company representative.
They will need to know the date of service of your tests,
the amount, and the name of the hospital.
If it turns out that the hospital is part of your insurance
plan, you will, first, need to make sure the insurance
company processed your bill correctly. Was your bill
processed in-network? Was there a deductible? Is there
a write-off? What is your financial responsibility?
If these answers do not correspond with the bill you
received from your local hospital, inform the insurance
company representative. If the hospital participates
with your insurance plan, they are under a contractual
obligation to accept what the insurance company allows.
They legally may not charge you for the write-off amount.
Your insurance representative can then advise you and
help you remedy the situation.
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