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?