I was referred by my PCP to a physical therapist and was going regularly to appointments where I was only charged a $15 copay. However, after one of my appointments where my PT used a new technique (biofeedback training), my insurance is saying that service is denied and trying to charge me upwards of $400 for this one appointment. My insurance provider is United Healthcare. When I go to their website and try to "estimate cost" of this procedure (code #90912) it says that it should be covered by my $15 copay. However, when I called United to ask why it was denied, they said that there was a form called a PRA that they sent to my provider and it was not returned, so they didn't have enough information and denied it. I was told by the provider, my PT, that she never got this form and I also reached out to the billing department for the medical group, Sutter, to have them try and follow up with insurance or look into it, and was told that they would and I'd hear back within 30-45 days. Now my insurance is saying that, since they denied my first appeal, I only had so long to appeal that and the deadline is approaching. The "patient advocate" told me that either myself or the provider has to write a letter to United Healthcare Escalation center and ask for a secondary appeal, but was super vague on what exactly to say or write. I called back Sutter, since it had taken so long. They said they had 30-45 "business days" to review it, but they'd mark it as highest priority. I don't think I should wait for them, but am unsure what exactly I can say to get United to resend these forms that my provider says she never received. Any guidance?

Age: 37 State: Ohio In December of last year, I was recommended to get a colonoscopy due to family history. When I spoke with the specialist doctor, he said that "since you'll be under (anesthetics), we could also do an EGD." He then asked if I ever get heartburn, and I said sure but it was infrequent and I knew the triggers and how to take care of it, but if, like the colonoscopy, my insurance completely covered it and I wouldn't be paying, I'd be okay with that. He said sure, they could do that. Fast forward a month later and the hospital is charging me because they submitted the EGD as diagnostic. So the doctor ignored the condition under which I agreed to the procedure. I've been fighting this ever since then. The hospital investigated and since they don't keep audio with the cameras, and don't have call logs (the doctor's assistant called me a few days beforehand and said they convinced my insurance to cover the EGD, and I confirmed with her that I wouldn't have to pay for it), they're refusing to do anything about it. The bill is about $1,900. I've filed a complaint/appeal with my insurance, but that takes up to 60 days, and is still going through the process (I had called them the day before the procedure and confirmed it's "covered," and the CSR said yes, she sees that that's been approved). I e-mailed the state department of health, talked with the state hospital association (they have no legal authority and can't do anything), filed with the BBB, filed with the state attorney general, filed with the Centers for Medicare and Medicaid, sent my story to the local newspaper, left a Google review, and am waiting to hear back from the state insurance department (they can't do anything until my insurance appeal gets resolved). My last option is to sue them in small claims court. The lawyers in my area said they don't handle cases like mine. What umbrella term would this fall under? Misrepresentation / promissory estoppel? The only lawyer who agreed to a consultation said it's better to go after the insurance company, but I don't see this as their fault. I can also call the hospital and negotiate a lower repayment, but I'm angry I have to pay anything at all when a promise was made to me that I wouldn't owe anything. Is this something I just have to bite the bullet on? Edit: Thank you to the 20% of people who explained what the hospital staff should have explained to me, gave me options to pursue, and ideas on how to protect myself in the future. The rest of you, I hope you understand that the vast majority of people don't work in this industry, and blaming the victim of a convoluted and broken system is real shitty.

Cardiologist ordered a CT for my heart. Pre-authorization approved by insurance but for cost estimate at BCBS website I will still roughly pay about 2K while they will cover about $1600. I have BCBS PPO with $3200 deductible. Would the hospital billing department be able to give me my actual cost before I go through with the procedure. I just don’t want any more surprises after getting hit with a $3K hospital bill for my son’s ambulance and ER TRIP.

I am getting some MRI's done at a outpatient facility and wanted to get an estimate by my insurance on my copay. My insurance asked me to get the NPI /taxid for the radiologist that will be doing the MRI so they can get the best estimate. I have BCBS I contacted the outpatient facility (NJ imaging network), and they gave me an NPI number but thats the NPI nubmer of the facility. I asked for NPI number of the radiologist, but they said that they bill under the facility, not the radiologist. How am I supposed to get an accurate estimate here? Also by "provider" billing I mean physician billing

What am I missing here? It looks like Anthem BCBS is acknowledging my provider is in-network and then processing it as out-of-network. * Provider has been processed as in-network for visits both before and after the visit in question, always with a $30 copay and no balance. This was another routine, non-emergency visit with the exact same provider. * EOB clearly says in big bold print that "Going to this doctor uses in-network benefits" and elsewhere has the words "(in your plan)" after the provider's name. * EOB shows no copay, a portion applied to my deductible, and a balance in the "Your total cost" column. * EOB gives a reason code: "015: The amount shown here is more than your plan allows for this care. If this was not an emergency, the doctor/facility might bill you for the difference between what your plan allowed and what the doctor/facility charged." How is this possible for an in-network provider? It seems this EOB is just contradictory on its face. I've been trying to get them to fix it, but haven't had any success yet. Any advice?

I have UPMC Advantage health Insurance and was taking Vascepa (icosapent ethy) and then the script went to $450 for a 3 month supply. In January i used a coupon from the Vascepa website and was able to get the medicine for $9!! ($3 per month) I just went back to the pharmacy yesterday (Giant Eagle) and they said that because UPMC no longer covers "Vascepa" I'd have to get the generic icosapent ethy, for which there is no coupon and it would cost $150 ($50 per month). Does anyone know how to get icosapent ethy for less? Also, why isnt there more outrage at the fact that our health insurers are constantly TAKING away from our plans and making it more expensive to get medicines we need?

Edit: It looks like this was my deductible. It looks like I didn't fully understand how things were billed before/after my deductible was met. Thanks for the help everyone! I recently received a bill for $275 from an in-home sleep study. When looking at my EOB it says that the ammount billed was $450 and Cigna negotiated a $175 cost reduction, however under "What Cigna Plan Paid" the amount is listed as $0. Also, the provider network status is listed as "IN NETWORK". I was operating under the assumption that this at home sleep test would fall under the other lab work from an independent lab category and would be billed at 15%. Not sure if this is necessary info, but I am located in California. My questions are: 1. Does anyone know what an in-home sleep study would be classified as when it comes to how it is billed? 2. Is it possible to contest this with Cigna to get them to cover more? 3. Is it possible to negotiate this bill with Virtuox in the event that Cigna will not budge?

I’m really hoping someone who works in medical billing at a dentist office can help me understand this. For context, I have Cigna Dental PPO. I had an oral consultation today that cost $167. The oral surgeon said I definitely need the bottom ones removed, but said she isn’t worried about the top ones. Then here is an image of what I was quoted after. They said I would either be paying $5809 or $3789 depending on what my insurance says. She didn’t sound confident in what she was saying and was speaking to someone else prior. Then, they tried to make me schedule it with 50% down as if I have $1800-2900 just laying around. I could barely afford the consultation fee. I’m I being got or is this how much people are paying to get their wisdom teeth removed? I’m so lost…

My 1 year old, went to urgent care first and then they asked us to take her to emergency as she was having trouble breathing. We went to emergency and her oxygen level was 82%. A chest xray and couple test later she had rhinovirus and bronchitis. She was admitted by the ER doctor to the hospital. My insurance denied the claim because they need more info from doctor, from which doctor ER or the pediatrician that monitored her at the hospital I'm not sure.I have the sydney app it shows the bill for the provider and also shows the plan discount paying the full amount of that bill so my total is 0. Is that pending the doctors note? Not familiar with how plan discounts work, I have blue cross HPN.

Hi! I took the SBMA MEC for just about a few months in late 2024 with a new job I started. I went to the doctors on November 12th and also received bloodwork but later I received a bill for $2000 for the bloodwork and $1265 for the Physician Office Visit. I am wondering if Minimal Essential Coverage doesn’t cover basic bloodwork? Last I was told, Labcorp was waiting to hear back from SBMA for covering the services but I guess the insurance never got back to them and I’m stuck with this bill :/ I will be contacting SBMA again and also Labcorp to see what I can do.