If I had two insurance plans for one hospital bill, how will the hospital separate the bill?

If I had two insurance plans for one hospital bill, how will the hospital separate the bill?
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#1

My wife was admitted to the hospital on 20th July for delivery. She has delivered the baby on 21st july and been there in the hospital till 23rd of July. I had the insurance plan of 80% coverage on 20th Jul and 90% coverage from 21st onwards.

The hospital charged me around $15000 as a total bill and the insurance is charging me 20% on the total bill without taking the 90% coverage plan into consideration.

When I asked the Insurance, they are telling me that they have a contract with hospital and cannot split the bill by date or service for the “Delivery”. So they can charge me 20% based on the admission date. I am loosing 10% coverage from 21st july to 23rd july even though the plan has been effective since 21st july. This is with insurance “UHC” and the hospital “Texas Health”. The hospital also telling me that they cannot split the bill by date or service since the insurance does not allow them to do so!.


#2

Congratulations !! This is a really great question!
The facility must be billing by a case rate and or Diagnosis Related Group (DRG).
DRG is linked to a fixed payment amount based on the average treatment cost of patients in a specific group or by Case Rate which is a bundled payment for a specific case.
Usually hospitals are paid on the “basis of the diagnosis” that they are treating; in other words, they are paid a set fee to treat certain kinds of conditions. Sometimes they pay hospitals a set fee, or “per diem” for each day or according to the number of days the patient was in-patient.
So once your wife was admitted on July 20th, “boom” the case rate/DRG went into effect with the cost sharing (your liability 20%). Had she been admitted on July 21st (cost sharing would have been 10%).
So, if they would have discharged your wife the very next day they would have gotten the same amount of money even if she stayed five days.
The sooner a patient is discharged the more money the hospitals makes and the longer a patient is there the hospital loses money.
So, I would agree with the insurance company and the hospital but it doesn’t mean you can’t appeal to both of them for a reduction in the bill. You always have that right.
I would also look into financial assistance with the hospital to see if you qualify. A family of three can normally make a little more than 50K and qualify for 100% write off. If you make more than that some hospitals will still offer a discount maybe 80%, 50% or maybe nothing at all.
Charity care is based on Federal Poverty Level and each hospital has their own guidelines and policies.
You can look on the hospitals website when you have time and check out the charity care guidelines to see if you qualify.
Best of luck to you!
Cheryl Welch, MBA
Hudson Valley Medical Bill Advocates


#3

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