reasonable and customary insurance?

Question

I am still trying to figure out what I can do about the reasonable and customary. In checking my insurance claims from 2005, I found that this hospital did negogiate the billing, should I of been notified that they are no longer a participating hospital? Or is this still something that I should of asked on my own?

Answer 1

aways ask your doctors and admitting desks if they are still accepting your insurance, and if so , will bit be payment in full? they can always drop the company when they want, and insurance never seems to get around to telling you.

Answer 2

You say the hospital accepted a negotiated rate from your insurence which that hospital was not part of their network?

If they accepted a negotiated rate, reasonable and costomary or not, they have then accepted a term with your insurence and you are NOT liable for billing charges over the negotiated rate.

If your insurence is simply telling you that a charged amount was over "reasonable and customary" but the hospital is not part of the network, the hospital is not required to reduce the charges by that amount and you would then be liable for any amount over what your insurence has paid.

The only way you can be sure the hospital accepted a negotiated rate is to get that document from your insurence company stating the hospital accepted the discounted rate payment. If the hospital is trying to recieve payment from you over the agreed upon negotiated rate, they are liable as long as you have proof of their acceptance of this negotiated rate.

Answer 3

Your network should have notified you of a change in your network hospitals and you should have asked prior to being treated.

As for reasonable and customary...No hospital or physician is required to write that amount off. There is a difference between "reasonable and customary" and a "negotiated rate".

Example:

Bill is $100. "Negotitated rate" through your insuance company is $80. The hospital and/or physician must reduce their bill down to the $80 - write off $20 and you cannot be billed for this - (IF they participate with your insurance).

Now, if the insuance carrier states that they are knocking off $20 because of "reasonable and customary", the hospital and/or physician is NOT required to write off this amount regardless of their participation status and they can bill you for this amount and you are responsible for paying it.

Answer 4

your question is very confusing. Insurance company generally notify insured the change in network.
If the hospital did negotiate billing then what you want to know?
In any case, neither insurance company nor you are obligated to pay above R&C charge in your area.

Answer 5

some informations

Answer 6

You should have asked it, they don't notify you.