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Medical Insurance Bill is different than Claim?


I'm hoping someone with some legal experience can help me. I got sick and had to go to the hosipital. I recieved a bill for about $780. I called and gave them my insurance info and they filed a claim for $1500.00. Is this normal for the hospital to tack on $800 because I have insurance? Would like some advice on what to do next, anything would help.

Usually a hospital or pharmacy will charge an un ensured patient, AKA a private pay patient, a higher amount for services. It is yet another example of how the poor in our country get gouged every day. This is what happens. If you are lucky enough to have a job with health insurance or can pay for your own insurance policy, you pay into a large health insurance organization. It is the goal of the health insurance organization to make money (hey it is the American way right?). So the health insurance company tells the providers (Hospitals, doctors, pharmacies) they are only going to pay a certain amount of money for services or they negotiate a lower rate for people that buy into their insurance. It does not really help out the people that buy into the insurance, it helps the insurance companies because they pay less for a service. People that can not afford insurance have to pay the regular or higher rate because they are not part of a group that has some bargaining power. So, you having insurance and then getting a higher bill after you gave them your insurance is odd. It is possible they did not have all your services on your first bill. You may want to call the billing department at that hospital and ask for a statement that shows ALL of the charges that make up that bill. Compare it to your first bill. You may find your answer right there. As long as you don't have to pay anything, you probably don't have to call an attny. If you suspect insurance fraud, you should contact your insurance company with your suspicions.

Ask for an itemization of the first bill and the bill submitted to the insurance company. Hospitals usually charge more to the uninsured.

Sometimes that first billing does not include all charges such as lab fees and etc....

I don't believe that's normal. I would ask for an itemization of the bill from the hospital. Contact the insurance company and explain to them what has happened. They will look into it, especially if they think fraud has been committed.

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