Should I pay these bills ? Or dispute ?
Hi, I’m confused with bills I received and any comment will be appreciated.
I had anthem PPO with $1k deductible remaining. I was pregnant and saw a in-network provider. Just regular in office covered visit. They were all paid by the plan. Example below. All the bills last year were paid by the plan.
Billed by provider $180.00
Plan discount – $106.03
Allowed by plan $73.97
Plan paid -$73.97
What you pay $0.00
Remaining ind. deductible $1,000 out of $1,000
Have a new pregnancy and saw the same doctor for same matter at same site. Standard covered pregnancy service. This year I have Empire PPO with $1.5k ind deductible. (In-network and same benefit)
Now this time I got many bills to pay – example like below
Total Billed by provider $195.00
Plan discount -$92.18
Allowed by plan $102.82
Plan paid $0.00
What you pay $102.82
Remaining ind. deductible $1,500 out of $1,500 This time the plan didn’t pay.
Additional context is that I switched anthem PPO to empire PPO in the middle of the year so it’s been a lot of issue on insurance’s side that it’s not properly recorded (termination not reported, out of network billing mark for in network billing etc) and I had to call like 10x times to figure it out for them. so I’m wondering if it’s also part of such error.
I’m confused what’s the difference in these two cases as benefits for the standard pregnancy doctor visit is the same under these two insurance and both times I had remaining deductibles. But earlier ones (anthem PPO ) is paid and the other(empire PPO) isn’t paid.
Could anyone guess what the reasons are? I called empire and they said whether it’s covered service or not I have to pay until deductible is met. Was I just lucky with earlier Anthem bills that they paid even though the deductible wasn’t met?
Any comment or idea would be helpful for me to better understand this and plan my doctors visit accordingly.
submitted by /u/Hot_Cranberries
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