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Over the past year I had my first experience with health care billing issues other than just paying my monthly bill. Something happened billing-wise recently that concerns me. I'd like to get feedback from the community as it's a potentially important issue.

I had a sports injury about a year ago. I went to the nearest hospital as I needed treatment ASAP. This hospital was out-of-network but my insurance would still cover the costs. Turns out the costs were relatively low (only a few grand). This fell under my yearly deductable so I paid out-of-pocket. To be honest I expected worse and did receive decent treatment so I just put the incident behind me.

Recently I recevied another bill for about a grand from the out-of-network hospital. This was a surprise as I immediately paid off my bills almost a year ago after the injury. I called my insurance and they said the total is still under my deductable so I need to pay it. Fine.

Here's my concern: can the out-of-network hospital and my insurance company stagger/delay the bills such that each year I'm technically under the yearly deductable?

Imagine another scenario where the out-of-network hospital says I owe 20 grand for a serious injury. If I'm billed all at once then I pay my deductable of, say, three grand and then the insurance pays the rest. However if I'm billed for two grand a year for ten years then I could potentially have to pay the entire 20 grand myself.

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This is obviously US, tagging as such –  littleadv Feb 3 at 22:28
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1 Answer

up vote 4 down vote accepted

You were injured in 2013. The treatment you were billed for was in 2013. Therefore it should be addressed by your 2013 insurance policy. If this newly found bill would have put you over the deductible for 2013, then it should be sent to the 2013 insurance company to be paid.

I hope that you sent the previous bills to the company so you were properly credited against the 2013 deductible. Also keep in mind that some policies have separate deductible and out of pocket pools for out-of-network bills. Further complications can occur if some of the medical services are in-network and some are out-of-network. The new healthcare law tries to address this issue.

They can't drag this out forever. The problem is that even the doctors have no idea how medical billing works. So nobody has an idea what the actual billed amount will be.

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Thanks for the info. Yes the 2013 deductable still hasn't been reached so the billing is technically accurate. –  SundayMonday Feb 3 at 22:27
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