jjr92

This is a very specific question, pertaining more to insurance costs. But if anyone can explain it any better I'd love the help.

I am looking over my explanation of benefits and I have my Amount Billed, $4,099.00. Then I have my plan discounts. For one of the line items this is -$3,114.00. My total "Amount Allowed" the number they used to calculate the coinsurance on, is $7,213 or $4,099-(-$3,114). Anyone know what is going on here?

As a side note, the hospital is telling me that the negotiated rate is $3,516.01. Insurance is telling me that the $7,213 is the actual negotiated rate. Insurance is supposed to be calling the hospital (I asked to be on the call).

Any insight anyone has into this mysteries of hospital and insurance billing would be appreciated.

Note: I have a pretty solid understanding of the concepts on the insurance wiki (copay, coinsurance, premiums, etc). But any insight would be greatly appreciated.

Edit: What I owe, in case you're wondering: $3,479.32. (7,213-1,879.17[my remaining deductible])*.3[my coinsurance rate] gives me my coinsurance of 1,600.15 + deductible of 1,879.17 = $3,479.32

Thanks so much, I will message you with the eob and hospital bill. Don't worry about spending too much time on it, I'm just trying to get familiar with standard practices so I know the right questions to ask. Most literature will just say, "the coinsurance is the rate you pay after you have met your deductible but before you've hit your max" that helps... Except when charges vary thousands of dollars between the hospital and insurance. Nobody ever really tells you how to deal with that.

But thanks for the work you do. This complex needs to be held accountable and good journalism is one of the only ways to do it!