Why Do I Have A Balance When My Insurance Covers 100% Of Emergency Room Visits?
The copay described in your benefit document is related to the hospital’s charges. When the physicians working in the emergency room are contractors who do not work for the hospital, they bill separately for services. Insurance carriers process these physician claims using either the Outpatient Benefit or Specialist Benefit from one’s policy. In most cases, the benefit applied is 80/20 after the deductible is met; meaning, the patient is responsible for 20% of the physician’s bill after the patient meets the deductible. If the deductible is not met, a patient could owe 100% of the bill. Please contact your insurance company directly if you have questions regarding your benefits.