Can you help me read this medical statement? (Probably not...)

In My Humble Opinion
1

I don’t think this thing was designed to be understood…

It doesn’t help that I have very little experience with dealing with medical expenses of any kind. Not totally a hundred percent sure about how insurance works, in terms of procedure and process…

Well anyway, here’s what it says:


[font=courier]

                                                          Charges        Payments/Adjustments      Insurance Amount       Patient Amount

Emergency Room:                                            $938.00
Co-Payment:                                                                      -$245
Default Self-Pay Refund Debit:                                                   $245
Hospital Services                                         $938.00                   $0                  $938                         $0

Outstanding balance: $0

I said “statement” above but I’ve just now realized that what I’m reading off of is not really a statement, it’s a page generated under the label “outstanding accounts.” There’s a different page I’d go to for “statements.”

My main questions are:

Is “insurance amount” the amount insurance paid, or the amount they’ve sent off to our insurance company to find out how much they will pay? And what’s going on with the “default self-pay refund debit?” We did receive that check, and had no idea what to make of it. And why is the co-payment listed as $245 when in fact we paid $350 (as reflected on my bank statement)?

Of course these are all questions I will ultimately have to ask the hospital and my insurance company about. But that’s two and a half days away! I am hoping there are some things here that are usual enough for people to know what’s going on even though I (being unexperienced) don’t understand them.

2

I am on Medicare, plus separate insurance for Parts B-D. Whenever I incur any medical expense I get a statement that fills an entire sheet of paper. Though I’m a reasonably intelligent person, I cannot make any sense of it. I start on the upper left and try to follow the reasoning, but there doesn’t seem to be any.

An example: A couple of years ago I had cataract surgery in one eye. I received statements for the surgeon, the anesthesiologist, nurses, assistants, etc., etc., and it seemed like everyone was paid. Then, about a month later, I received a statement to the effect that $8,000.00 was charged for use of the building when the surgery was performed. Then it said that my insurance paid the amount in full.

I no longer even try to understand these things. If the “outstanding balance” is $0, I don’t need to understand anything else.

3

nm