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My wife and I live in New York City and recently we had a baby and my wife stayed in the hospital for two nights. She has insurance through her employer, which is her primary insurance, and she is also listed on my insurance from my employer, which is her secondary insurance.

We just got the hospital bill and something seems very wrong. The total charges for the hospital stay were $30,000. The hospital sent these charges to the primary insurance (with whom the hospital is in-network) and the primary insurance paid to the hospital their contracted rate of $14,000, minus a $400 copay which we owe.

The hospital then sent the remainder of the charges ($30,000 - $14,000 = $16,000) to the secondary insurance, which paid some percentage of it. Now we are being asked to pay $5,350, which is the remainder that the secondary insurance did not pay.

So we are being asked to pay extra despite the fact that the hospital is in-network for the primary insurance, which fully paid for the hospital stay based on their contracted rate. The hospital billing person whom I spoke to confirmed that if we only had the primary insurance, we would only be expected to pay the $400 co-pay. But somehow, also having the secondary insurance means we have to pay $5,350.

This can't possibly be correct, and I believe it is an example of "balance billing," and illegal. Is this accurate, and if so, what can we do about it?

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    @HartCO They state that they're in NYC, so New York.
    – mkennedy
    Apr 12, 2022 at 15:03
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    @mkennedy Ha, thanks, I wasn't paying good attention, added tag.
    – Hart CO
    Apr 12, 2022 at 15:25
  • Normally, when insurers have a contracted rate for a service, the contract prevents them from billing anything above coinsurance from the insured. This definitely looks wrong. Apr 12, 2022 at 17:28

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I agree with you. That can’t possibly be correct.

I would talk to someone at your primary insurance company. Explain to them the situation, and tell them what the hospital told you. They have an interest in making sure you are not billed for something you are not supposed to be paying.

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    '...They have an interest...' - Do they? Why would your insurance care what you pay? I'd rather expect the secondary insurance would have a big interest to get their money back, which they shouldn't have had to pay, so I would talk to them?
    – Aganju
    Apr 12, 2022 at 22:18
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    @Aganju Your insurance company definitely cares how much you have to pay. They have a contract with the in-network providers that they won’t charge you more than the contract allows. It is part of the value that the insurance company provides to you. If nothing else, you being charged too much means that you would hit your out-of-pocket maximum before you normally would. Yes, the secondary insurance also has an interest in fixing this.
    – Ben Miller
    Apr 13, 2022 at 14:53

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