Riverson
CHA PLEASE
- Joined
- Aug 25, 2011
- Messages
- 783
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Your post "That bill was 20K for 6 hours of care, exrays, CAT, sutures, whatever.
Anthem refuses to pay any more than 5K "because Arrowhead is not in their network".
I agree with Dave that you need to dig into your policy to see what is covered, what is excluded, limits of coverage, exceptions and most importantly the methods available for dispute resolution (mediation, arbitration).
Our company handles CA workers compensation and employers liability. The hospital bill you received is the rack rate/cash customer charge for each and every service you received as a patient (services, tests, medications, durable medical equipment, supplies). Did Anthem actually pay $5,000 or was that their offer to pay? Is this amount the limit of coverage for an out of network provider or is it 25% of the billed amount? Where the charges reviewed by Anthem---what would the bill be if it was a network hospital? I can tell you that a network reimbursement amount under the network contract is going to probably be less than half of the full rate billed by the hospital.
You will want to gather information, have a multiple angles of attack and defer any agreement to pay.
Good luck...if you have additional information be sure to reach out.
This is great advise! He is dead on with charges not even being close to what is recovered. Margaritaville, who do you work for? We may be on different sides, but I am sure we know each other! I may have even taken your testimony. My companies represent payees not carriers.
Is this Teddy or Milt? My guess is you are Milt?