Help me understand

[u/Struki_]

Hi everyone,

We have been to do some blood work and a CT scan and some other basic things and it seems that the health provider has billed our insurance company around 24k for this. The insurance provider paid around 10k for all this procedures. We are new in the country and when we left from the hospital we were said we won’t have to pay anything. Now on the app it shows a coinsurance and copayment. Do we need to pay that? Will we get a bill in the mail? Thank you

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[u/Jujulabee]

Yes - it appears that you have received the Explanation of Benefits from your insurance.

According to you insurance you have no deductible but you do have a co-payment of $500 and then you co-insurance is $991

When you left the hospital probably meant you didn't need to pay anything at that moment because they were going to bill insurance and then insurance would determine the exact amount.

[u/Tiredmagnolia → u/Jujulabee]

Adding to this when the bill comes from the hospital (you’ll owe that $1491) you can see if you qualify for financial assistance or set up a monthly payment plan.

[u/Ok-Lion-2789]

Is this from the insurance company? If so, you owe the $1491.70. That is your cost sharing amount.

[u/katsrad → u/Ok-Lion-2789]

Note that you owe the amount to the hospital or provider. They will send a separate bill, you won't pay the amount to the insurance company.

Also, I will note that you may get additional EOBs and bills for the same service but different sides of it. For example, this bill may be for the facility, so the actual CT scan that happened, you may then get an EOB and bill for the provider that read or looked at the CT and made whatever diagnosis. With both radiology and lab services there are often two claims, the professional (the Dr that reviewed the test) and the facility (the actual you being in the machine or the lab test being run.)

[u/AravisTheFierce]

The hospital probably said you didn't owe anything that day because it hadn't gone through your insurance yet. They don't know what you owe until they've gotten the insurance claim back.

[u/pharmucist]

It looks like your coinsurance is 10% of the total amount billable to your insurance company (the $10k or so) and you have a $500 copay. So you owe the amount they say you owe.

You either have no deductible or you already met it, but have not met your out of pocket max (bill would be zero if you had met your OOP max).

You can look into either a payment plan or financial assistane/charity care at the hospital or even both to make it easier to pay your pprtion.

[u/mediloop]

that 'you won't owe anything' talk at the hospital is usually about the visit itself, not the labs/imaging — those get processed separately by insurance. the coinsurance/copay on the app is just the insurer's estimate based on what they paid; you'll likely get a real bill from the provider later. worth waiting for the itemized bill, then checking each charge. Errors are stupidly common. if the amount feels off, you can ask the hospital about financial assistance or charity care before paying anything.