BC&BS story
My wife had to be hospitalized recently..The hospital doesn't have semi-private rooms. Only private rooms
The Hospital billed BC&BS for a private room. BC&BS sent us our EOB sheet which said,," we don't pay for private rooms, however we will pay the amt. specified in our contract with the hospital for a semi private room"...Normally because of that contract, the hospital accepts the specified amount plus our 10% co-pay for any services rendered..
The hospital now wants us to pay the entire difference between the semi-private room (which BC&BS paid for) and the total cost of a private room, even though there are no semi private rooms in the place, and we were not given a choice.
We appealed to BC&BS stating the obvious..The hospital should only be charging us the 10% co-pay on the specified amt that BC&BS is required to pay for a room.
BC&BS denied the appeal but said.."we have never heard of a hospital passing the difference on to the patient. They usually accept the co-pay and move on, however your dispute lies with the hospital as we have no influence in the matter"..Thats bullshit cause they have a contract with the hospital to accept the negotiated amount for services rendered..
We have refused to pay the difference to the hospital and the last communication we got was from the hospital saying they are turning it over to collections..
Ya cant win I tell ya.