Balance Billing

[tprranc]

What is the name of your state (only U.S. law)? Pennsylvania:

My wife and I have Health insurance with Geisinger Hospital,which is Geisinger Sponsored Health Insurance; I have read over the insurance Plan very intently,and it says nothing of balance billing,They stated Co-insurance on the specifics that we have had done,But the percentage is O,we have paid the Co-pays.and there is a deductible of $750.00,but I assume thats for major Surgery. I have checked on the Internet for information on Balance Billing in Penna,But its very sketchy,and non-pointed. What I need is something that is a Real Law on Balance Billing so I can show them what is what,and to stop this arbitrary practice of Balance Billing from the Hospital,Because if its wrong,Then its wrong.Besides a lot of Seniors go the Geisinger on a given day,and they are the ones that suffer,and are taken advantage of because of this Balance Billing practice. Thank you!What is the name of your state (only U.S. law)?

[lealea1005]

Originally Posted by tprranc

What is the name of your state (only U.S. law)? Pennsylvania:

My wife and I have Health insurance with Geisinger Hospital,which is Geisinger Sponsored Health Insurance; I have read over the insurance Plan very intently,and it says nothing of balance billing,They stated Co-insurance on the specifics that we have had done,But the percentage is O,we have paid the Co-pays.and there is a deductible of $750.00,but I assume thats for major Surgery. I have checked on the Internet for information on Balance Billing in Penna,But its very sketchy,and non-pointed. What I need is something that is a Real Law on Balance Billing so I can show them what is what,and to stop this arbitrary practice of Balance Billing from the Hospital,Because if its wrong,Then its wrong.Besides a lot of Seniors go the Geisinger on a given day,and they are the ones that suffer,and are taken advantage of because of this Balance Billing practice. Thank you!What is the name of your state (only U.S. law)?

Is Geisinger your primary health plan, or is Medicare?

More specifics about your situation will make it easier for us to answer your question. Are they billing you for the deductible?

[tprranc]

Geisinger is our primary health care insurer

[tprranc]

As for the deductible,That I don't know,There is no stipulation in our Plan for that,But as I stated earlier,there is a Family deductible,of $750.00. But a deductible in my Mind is not adminisitered or applied to a Office call and visit

[lealea1005]

Originally Posted by tprranc

As for the deductible,That I don't know,There is no stipulation in our Plan for that,But as I stated earlier,there is a Family deductible,of $750.00. But a deductible in my Mind is not adminisitered or applied to a Office call and visit

Were there any procedures done during the office visit (such as EKG)? Have you asked for a detailed explanation of the charges?

[tprranc]

Yes, I had an EKG,I could FAX you any and all the Information I have. I llived in New Jersey for 14 years,and I had Horizon BC/BS as our Health care,and I was Balanced Billed,and Called Provder,and I got a call from the Billing person,and she apologized all over herself,because,In New Jersey its against the law to balance bill,This is why I'am having such a time with it. Insurance Companies and Dr's have an agreement to except Insurance rates and Pays,Not bill you above and beyond unless its noted ahead of time,or explained,There is NO explaination on any of the Bills I have recieved,It just says; " You Owe". Hence the Problem!!!

[lealea1005]

Originally Posted by tprranc

Yes, I had an EKG,I could FAX you any and all the Information I have. I llived in New Jersey for 14 years,and I had Horizon BC/BS as our Health care,and I was Balanced Billed,and Called Provder,and I got a call from the Billing person,and she apologized all over herself,because,In New Jersey its against the law to balance bill,This is why I'am having such a time with it. Insurance Companies and Dr's have an agreement to except Insurance rates and Pays,Not bill you above and beyond unless its noted ahead of time,or explained,There is NO explaination on any of the Bills I have recieved,It just says; " You Owe". Hence the Problem!!!

You should insist upon getting a copy of the itemized bill.

If your policy has a deductible for surgery or procedures, you may be getting billed for the EKG....however, they don't cost $750.

ETA: Remember, you may live in NJ, but the services were provided in PA. Oh... and you're sure the Physicians are contracted providers for your insurance, right?

[tprranc]

I don't Live in New Jersey now, I live in PA. The Physicians are Employed by Geisinger,And there is no stipulation otherwise.

[ecmst12]

You are confused. It is not illegal to balance bill in NJ. It is illegal to balance bill if the provider is contracted with the insurance company, and the insurance company requires them to write off a portion of the charges. If the provider has no contract with the insurance company, they can bill for anything the insurance doesn't pay - legally, in all 50 states.

The deductible can also be applied to ALL services, including an office visit, if that is how the plan is written. Many plans do not apply the deductible to office visits, but plenty of others do, and that's legal.

You need to call your insurance company and ask them to explain what you are responsible for and why.

[tprranc]

Thanks for all the Information,and your time,I appreciated it all,I will contact My Insurance Provider and find out what is what!! Thanks Again! Really!!!!!!