15 min Urgent Care Visit Bill came out to be over $2000 after insurance coverage
Hello, I'm seeking help with a unexpectedly large bill I received. In early April, I experienced symptoms of a yeast infection, but my primary care provider's appointment was postponed due to her attending a conference. Consequently, I visited an in-network urgent care facility in Boston, MA, affiliated with a hospital different from my PCP's.
At the urgent care, I consulted with a PA who conducted a urine test and a 'self-swab' test, sent out to labs for analysis. The tests, consisting of six different procedures across regular and pathology labs, were billed with specific CPT codes totaling approximately $3200. My insurance covered around $1200, leaving me with $2000 to pay out of pocket.
Shocked by this amount, I contacted both the provider and my insurance company. The provider claimed the insurance had applied an unusual charge/coverage method, while the insurance affirmed the charges were correct. The provider suggested the insurance typically doesn't apply the entire amount to the deductible, potentially inflating out-of-pocket costs, which confused me.
Despite using the insurance's cost estimator tool beforehand, which indicated a much lower cost after insurance, and the provider's estimator showing $0 after insurance, the initial charge was significantly higher. My insurance is United Healthcare through my employer, with a $1750 deductible and a $5000 out-of-pocket limit, both of which were unaffected until this visit.
I have several questions:
Could this be considered 'Surprise Billing' even though it was an in-network facility? (The provider sent a print about 'Surprise Bill Rights and Protections' along with my bill which makes me think if I should raise an issue to information they provided me of)
What does the provider mean by the insurance billing everything to the deductible is unusal? Shouldn't insurance charge to deductible anyways? But due to this large cost, the insurance explained that the bill was processed with 60/40, 60% on deductible and 40% on coinsurance per code until it was met then went over to out of pocket limit.
How accurate is a cost estimator, and why would it differ from the actual bill? How can I use this information for an appeal?
The insurance mentioned I need to pay 20% of any bill from now that my deductible is met, but I still have to pay up to $5000 until my out-of-pocket limit is met. Does this mean any future bills will also require me to pay until I reach the $5000 limit for full coverage?
If someone could please explain any of this more clearer, it would really help me out. Please help. Thank you.
submitted by /u/Immediate-Music-9851
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