Hospital bill re-submitted; deductible zeroed and hasn’t recovered (US-CA)

Back in February I had surgery for which I paid over $2000 to the hospital. My Anthem BC status went from "you pay 100% until you reach the deductible of $1000", past "you pay a percentage", and straight to "plan pays 100%" after they approved the hospital's claim. Excellent.

A few weeks later the hospital re-submitted their claim for whatever reason, just a few dollars here and there, nothing extraordinary. My plan status reset to "you pay 100%" and the amount I'd shown as paying for a deductible went back to $100 roughly for some other visit. Anthem assured me that they were reviewing the re-submitted claim at that point and my status would change after. Well, it didn't. The re-submitted claim shows as approved. It shows that I paid around $2000 co-insurance for this claim, and $0 in deductibles.

If I look at this subreddit's stickied FAQ it says coinsurance is "The percentage of costs of a covered health care service you pay (20%, for example) after you've paid your deductible." followed by "If you haven't met your deductible: You pay the full allowed amount" which seems to contradict the first statement (my emphasis).

I thought that co-insurance kicks in after the deductible was met, but my claim and status show $239.11 deductible paid (out of $1000) as of today.

My second chat with Anthem ended without any explanation, she just seemed confused.

My third chat went on for an hour while she consulted with other people. In the end she escalated it to her managers saying somebody would get back to me. Nobody has ever gotten back to me.

See also  Misrepresentation of billing practices

Have I completely misunderstood this whole thing? It just seems odd that in March/April, after the original claim was submitted, I was getting "free" healthcare for doctor visits/labs/prescriptions (the latter even for prescriptions I'd always previously paid for) with "plan pays 100%" on my account, had an endoscopy under sedation for something like $40 oop, and then after the claim was re-submitted I'm back to square one with co-pays to doctors and prescriptions back to their normal prices.

My head hurts. Thanks for any help understanding this.

submitted by /u/GeoffSim
[comments]