In Network Services Not Covered, no Member Liability

I have an EOB for $30,000 worth of in patient services, room and board, radiology, inpatient hospital services.

Cigna is coding all of it as VL4 XDP Notes VL4 – SERVICE NOT COVERED DOE S NOT MEET THE DE FNITION FOR MEDIC ALLYNECESSARY CARE OR TREATMENT. XDP – ACCORDING TO THE PROVIDER CONTRACT THE ITEM IS NOT PAYABLE AND THERE IS NO MEMBER LIABILITY

It's saying the amount billed is 30K, while the amount not covered, the amount allowed, the copay, deductible, plan liability, coinsurance, and what I owe are all $0.

This is for a fractured pelvis that required CT scan, x rays, in patient care, physical therapy, and 3 days in hospital.

I've called Cigna twice and gotten various answers between "don't worry about it, you owe $0" to "this is incorrect and we are working on it".

I need to get my wife (the patient) into the room with me to get any traction with the hospital billing department

What are the likely outcomes here? Should I just let it work itself out? I don't really feel like waiting around for a 30k bill from the hospital to take to Cigna, and 3-way a biling code resolution. If somehow possible I'd like to get the hospital to re bill under the appropriate codes, which I assume is the issue here.

What do you all think is the cause of this strange EOB?

submitted by /u/crankedbyknot
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