We are starting to slog through all the bills from my recent surgery.
In many cases, the hospital will bill the insurance company at less than their standard rate - sometimes substantially less. My wife maintains that we are not responsible for the difference (otherwise it would be double-billing) - we are only responsible for the amount that the insurance doesn’t cover, after the discount.
I am trying to find the statute that covers this. I’ve looked through the Arizona Revised Statutes, but I can’t find anything. Are there any Insurance / Medical Dopers who can point me in the right direction?
After my accident, my full bill was over 850,000, insurance paid around 625,000 as per their agreement with the hospital. I was only responsible for co-pays.
You absolutely do not have to pay the difference between the billed price and the negotiated price. If your coverage pays 80%, you are responsible for 20% of the negotiated price. (For example, I recently had a procedure done that cost $1200 but my insurance negotiated fee was $1000. They cover 80%, so they payed $800 and I paid $200.
Your insurance carrier probably sent you a piece of paper called a “Statement of Benefits” that had the billed and negotiated fee on it. If that is what you are looking at, don’t worry about it. Wait until the actual doctor’s office sends you an actual bill that says “You owe $X”. This can take a surprisingly long time. If they send you a bill that matches the difference between what your carrier paid and what they charged, they are screwing you and you need to call your carrier. They will fix it very quickly–double billing is a big no-no. If fact, it’s outright theft.
Yeah, you shouldn’t be looking through statutes, you should be looking through your insurance policy. It’s not a matter of law, it’s a matter of the contract between the providers, the insurance company, and the patient (you).
ETA: To echo what Manda JO said, the really important information comes on the Statement (or Explanation) of Benefits, on which the insurance company tells you how much you really owe. And then the actual medical bill often doesn’t come for months after that.