BCBSM EOB Notes
Hi all, can someone explain to me what this means?
I was seen earlier this year by a local hospital/women's clinic as I was pregnant. On my hospital bill, I have 2 dates of service that are totalling almost $2000. They have sent me several bills and on the latest, it says the account is past due and the total is due upon receipt.
When I look at the EOB (from BCBS of Michigan) for the first date of service, it shows the total amount that the hospital is billing me and under it says: "OUR RULES DEFINE THIS SERVICE AS ONE THAT'S NOT ELIGIBLE FOR PAYMENT BASED ON THE WAY IT WAS REPORTED. WE'VE NOTIFIED YOUR PROVIDER. UNLESS WE RECEIVE A NEW CLAIM, WE OWE NO PAYMENT FOR THIS SERVICE, NOR DO YOU. THIS SERVICE IS NOT PAID SEPARATELY. IT'S INCIDENTAL TO A SERVICE FROM THE SAME DATE THAT HAS ALREADY BEEN CONSIDERED FOR PAYMENT. MOST HEALTH CARE PROVIDERS ACCEPT OUR DECISIONS. WE SAY THOSE PROVIDERS PARTICIPATE WITH US, AND THEY SHOULD NOT ASK YOU TO PAY. FOR SERVICES OTHER PROVIDERS PERFORM, YOU MIGHT OWE ANY AMOUNT NOT PAID BY YOUR HEALTH CARE PLAN."
The EOB for the next date of service says the same about not being eligible for payment and owing nothing for the service under the numbers. Except this one shows the total the hospital is billing me (almost $1000) and then says the "approved amount" by BCBSM is around $250 and says "amount you pay: ~$250"
Our family deductible is $500 and out of pocket max $1000, which has been met already. Both visits were for pregnancy care and my insurance plan documents show "maternity services" covered at 100%.
submitted by /u/longbodytinydog
[comments]
