Negative Plan Discount – What does this denial letter mean?
Hello, I had an emergency room visit in early July. Total billing was $4200 and the EOB states that the amount saved was 1,640 for a CT Scan and negative -$799 for the ER Room Charge (99284). That netted out to $841 covered by UHC. The rest or 3,359 was billed to me by the provider.
I understood this negative amount to be the difference between what the provider actually billed and the contracted rate between the provider and United Health Care. I.e., the contracted rate was larger than the actual billing. So I took the next step and appealed the claim and was denied, but got what I think is strange response that I don't know how to interpret.
"Pease be advised that the rates for services rendered by network providers are mandated by our contracts with those providers. Your plan strives to offer you the best coverage while keeping costs down. These contracted rates have been agreed to buy your provider as a way to reduce your out-of-pocked expenses. Please understand that we are required to abide by the terms of our contract with your provider.
You are not responsible for any differences between the amount billed by your provider and the contracted rate for any covered health service. You are responsible for any copayment, deductible, and coinsurance amounts, according to the terms of your health plan.
Additionally, the negative amount is the amount saved. You do not owe this amount because either (1) you chose a network provider that gives us a standard discount, (2) you chose an out-of-network provider that agreed to an amount less than billed, or (3) it is a surprise bill and the law protects you from having to pay it. Per contract the"
… and it ends there midsentence.
What gives? It sure sounds like I'm not responsible for this $799? Do I have a way out of this or how should I interpret this letter?
A snapshot of the EOB and letter is here: https://imgur.com/a/gpRwiF2
submitted by /u/Koelsch
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