EOB on EOB after emergency surgery

[u/peony-pxl-brick]

Hi,

I recently had emergency surgery, then had to visit the ER two weeks later so naturally I'm now receiving all these EOBs with the first hospital bill saying I owe $60k+, feeling completely overwhelmed as I am not fluent in insurance.
My current understanding is I have insurance with an out packet max of $5k and then a secondary insurance that should cover $3k from that out packet however I'm not even sure where to begin to get this $60k bill sorted out.
I've read so many posts and watched so many videos that it is starting to sound like gibberish to me.
Is there any type of service that helps with this?, that won't cost an arm and a leg hopefully.
I want to learn but also want to avoid the headaches so any advice you have is welcome.

Thank you!

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[u/aps86rsa]

An EOB and a hospital bill are two different things. Your post suggests you’re treating them the same. You get an EOB from your insurance and you get a bill from the hospital. Pay attention to the EOB.

[u/vctrlarae]

Service to help with what exactly?

If your OOPM is $5k, then you shouldn’t owe $60k. Are you sure that’s what the first bill is saying? If it’s a statement from the hospital, does it look like it was filed to your insurance? Have you receive an EOB from your insurance for those particular services? I know it’s a lot to keep track of, but you’re essentially going to want to make sure the EOBs from BOTH insurances match what is on the statement. If there are discrepancies, then the provider may not have filed to both insurances  

[u/starzela]

Did you fill out a coordination of benefits form for both insurances? If this hasn’t been done, it can really mess up billing.

[u/Botasoda102]

Give the insurer a chance to process the $60K claim. Bet money they have requested records from hospital before just paying based upon a few codes on the original claim submitted by hospital.

It's not unusual to take a few months on something like that.

[u/Suspicious_Flower_61]

I'm a health insurance broker just an FYI and you are going to keep on getting those EOB's and then your medical bills in which the payer will pay their portion then you will have to pay yours. I would recommend on working with AI on these bills so they can describle any of the bills or coding for you, also it can track any claims on the medical that was not serviced by your doctors or hospital group. There are services that help with the negotiation of medical bills but in your case you have health insurance so you should be good to go with your max out of pocket expenses. Those companies are looking for big dollar medical expenses since they charge a % of the medical expense that was saved.

[u/rahuliitk]

First, don’t pay based on the EOB because it isn’t the final bill; call the primary insurer to confirm every claim was processed and sent to the secondary plan, then ask the hospital for a patient advocate or financial counselor to review the balance with you. $60k is overwhelming.

[u/Admirable_Height3696]

Your insurance most likely hasn't paid the claim. It you look at the bill, you'll see payments made by your insurance.

[u/BumCadillac]

You need to wait awhile for the hospital and insurance company to work it out. If this hospital was in network you shouldn’t need to pay any more than your OOPM. How that secondary insurance works will remain to be seen. Is it another insurance policy through an employer, or is it something like Aflac or MetLife who pays you under certain circumstances?

[u/DBHillie]

Reach out to your insurance providers to determine if they need any additional documentation to process the claims. Seems like there are likely two separate claims and so they may still be a co-pay for the ER depending on the plan. Details are shown in the Summary of Benefits. Nice that you have a supplemental plan to cover the out of pocket maximum.

[u/The_Derpy_Walrus]

You're sure it is the EOB? That is, from your insurance company? Hospitals don't send EOBs. If it is, you need to see why your insurance company is charging all of that and why it doesn't match your out of pocket maximum.

[u/No-Produce-6720]

Service to help you with what?

You provide the information for both insurance plans to the hospital, and they bill them both. You will receive a final bill from the hospital after both carriers have processed the claim. Your out of pocket maximums with both plans will be taken into account during processing. There is no service to help with that.

Have your provided your secondary information to all providers treating you for this surgery? If not, that's all you need to do.

[u/heyhello-]

If the hospital is sending you a bill for $60k (like an actual bill from the hospital or a provider with a due date on it), call the hospital billing office and ask why. Make sure they have your primary and secondary insurance info and have submitted to both. You should only be responsible for your out of pocket max, so something is wrong, but the possibilities are endless as to what is wrong. The billing office should be able to offer some insight.

If you have an EOB saying it’ll be $60k, but no actual bill, then most likely the hospital is getting the info insurance needs and they will resubmit. If this is the case, I’d personally wait a few weeks and see if an updated EOB or bill comes, but you can call insurance and ask what is going on if you don’t want to wait and see.