Hospital charged me for more than insurance claims that I owe

Question

I recently had a medical procedure done that had a number of diagnostic tests leading up to a surgery. All of the various bills from that went through insurance, with me paying the out-of-pocket expenses after the fact.

The one exception to this was the hospital fee. I was charged over $2000 while checking in, based on what my insurance was going to pay. I have no idea whether that's normal, but I didn't see any other option, so I paid it then and there.

Two months later, I received an explanation of benefits letter from my insurance showing that my out-of-pocket cost for the hospital visit was $1100. None of my insurance claims reference this $2000 expense, so either there's more information to come, or I've been overcharged.

My guess is that my insurance negotiated the cost down, but I'm still out $900. Do I need to contact the hospital or my insurance? What are my options?

As a side note, all of the other bills are accounted for. My X-rays, MRI, lab fees, anesthesiologist, and surgery were billed separately, and they align with my insurance documentation. The hospital fee is the only outlier.

Answer 1

It is not uncommon for a provider - hospital or doctor's office - to miscalculate your share, and initially overcharge you. They would of course owe you the money back, you should simply call them and ask for it.

Some providers pay you back on their own, without a trigger, although it might take some weeks for them to act; others wait until you call and ask for the money, and - unfortunately - some make it very hard for you to get it back, with all kinds of excuses.

I had cases where it needed nine weeks, over a dozen calls, and three in-person visits until they were 'able' to reimburse me, with all kinds of funky excuses - 'the only doctor that can sign checks already left for the day', 'our check printer is broken', 'the check is in the mail' (bold lie), etc. I finally sat there and loudly declared I won't leave until I get my check, with the whole waiting room being able to hear it (and the next step would be a lawyer).