Did not go through insurance for ER visit, paid out of pocket, submitted claim afterwards and now they claim I owe 3x what I was charged?

I went to the ER for an eye infection. At the ER, they did an eye stain and then prescribed me antibiotic eyedrops. I only saw 1 doctor. While at the hospital, I could not find my insurance information, so I did not go through insurance and I paid out of pocket for $474 for the service upfront and after I received my service. They did not let me leave without paying, so I was and still am under the impression that this was the total cost of my services.

Later, I submitted a claim to my insurance, expecting that they would be able to reimburse some of the cost, especially since the hospital is listed as in-network. They approved my claim but stated that I owe $1,148.18. According to the insurance company, I was billed $3,053 for the total cost of services. This does not make sense, as why would they let me walk out of the hospital with only paying part of the cost?

I called my insurance and they stated the $474 was denied because this service is a "vision service" and should therefore go through vision insurance. I contacted my vision insurance and they restated that the charge should actually be billed as a medical service since it's not a routine eye exam/check and because it's dealing with a medical infection of the eye. Also, for this is $474 charge, they listed the doctor as "XYZ Hospital" which is the hospital and said that "the doctor" was not in my plan (they did not specify the doctor). However, insurance claimed a secondary charge of "Emergency Service" for $3,053 and also listed the doctor as "XYZ Hospital" but said this time that the doctor was in my plan. Factoring in discounts, I owe $1,148.18. They listed the same "doctor" in both charges but only one was in-network and the other was not, which doesn't make sense.

I am also very confused because when speaking to insurance regarding the secondary charge, the agent told me that there are 2 charges: one billed by the hospital ("Emergency Service") and one by the "doctor" ("Vision Service"). However, as mentioned, they denied the doctor charge and they also listed the hospital for both charges. These discrepancies and the fact that a secondary charge was applied only after I submitted to insurance makes me suspicious. I paid the hospital the total amount due upfront and right after my service was rendered during checkout.

I feel like I paid my total already, which was $474. Only after going through insurance, they decide to tack on more charges and gave me the runaround when I asked further. Can someone help me out?

submitted by /u/sillzhanz
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