When billed on something the insurance says they didn't allow anything and I owe nothing, what does that mean?

Question

I recently got a medical bill and it listed all this stuff from when I seen in a hopsital and prices and it said the insurance didn't allow any of it and I didn't owe anything, does that mean I don't pay anything or what? I am confused

Answer 1

It could be one of four things:

1. The hospital did stuff that's not covered by the plan - like labs.

OR

2. It was covered under a Capitation agreement - which for hospital stuff is unlikely.

OR

3. The insuranced f-ed processing the claim and the hospital has to have it reprocessed.

OR

4. It could be just being repriced - if you have a plan thru a union, they use a third party (usually Magnacare here in the Tri-state area) to price the claims before the union pays them.

To cover yourself, you should call your insurance and ask them exactly what's going on. Almost all insurance companies log every phone call that comes in, so there will be a record if they tell you not to worry about it and you don't have to pay anything. (In which case, get that person's name and title - in case you need to call back!)

Answer 2

I got one identical to that! Lol. I was told by the doctor's office that it just means that they had not yet filed the bill with the insurance office yet. It IS confusing isn't it? If you are sure you are covered for the services listed on this claim, don't worry, and just wait a while. The insurance company will send you another letter soon enough that will make more sense.

Answer 3

If you used a contracted participating provider/hospital in your health insurance carriers network, it is most likely that you owe nothing on this particular bill. It sounds like you did not receive a bill though, but an EOB, (explanation of benefits,) from your insurance company. You most likely will receive a bill/statement from the actual doctor/hospital in the mail. That bill/statement should reflect the same information as the EOB. If not, and the provider of care wants more than any co-pays owed, I would let the insurance company handle it.

Answer 4

Sounds to me like unbundled services. For instance, if you have surgery, all follow up care is covered for free for 30 days post op. It may be that the itemization included services that were included in an earlier listed charge (when you charge to take blood, you can't later charge for the needle and vial too since that is part of taking blood). If you have a question, call the insurance company or read the explanation of benefits and code explanations on it and it will say why the charges were denied or reduced.

Answer 5

Double check. If the insurance didn't pay for it, I'm sure the hospital is going to expect you to pay for it.

Answer 6

call them...
Sounds like insurance double speak to me...