Pretty new to US - came down from Canada recently. So, not used to the medical/insurance system here since everything is free up in Canada!
My daughter had to go to ER a few weeks ago (in ambulance), and she was transferred from the ER of first hospital to ICU of Stanford's children's hospital (via another ambulance) b/c the first hospital was not equipped to deal with her.
The bills are starting to roll in (via insurance provider), and the first shady bill was related to an ambulance charge where my insurance provider has stated that the "out-of-network" provider has billed ~$10K but the insurance provider feels ~$2K is the "Recommended amount" that should be paid given what service entailed. My policy covers $100 flat fee for emergency transportation. Funnily, there is no field for "how much I owe" as in other letter's I received - and just a "recommended amount" to be paid, without really saying explicitly that I MUST pay it. Are these guys hoping that I hadn't read my policy and I didn't see the nuances in their letter and hoping that I would just "pay" $2000? Or maybe it's just a case of them not writing their "for your information" letters sufficiently clearly?
The second "issue" is related to the hospital room/board. If it's an emergency room stay, I need to pay a flat fee. However, if it's a hospital stay / hospital room, I need to pay a co-insurance fee as a percentage - which is a few thousand dollars. My daughter was for the most part in ICU - and not the regular hospital wing. Does ICU typically fall on the ER side of the fence or the "regular room" side of fence?
Also, as a point of general interest, the hospital has billed like 110K for the stay, while the insurance provider has "negotiated" this to around 30K.. Weird. So, if someone doesn't have insurance company that will negotiate on their behalf, does such a person end up paying 110K?!