Over a year ago, I went to the emergency room, paid my copay, and thought everything was fine. Now, my insurance has reversed their payment, and I’ve received a letter saying if I don’t pay $600 in 15 days, it will be sent to collections.
I also have a $1200 bill from another visit that insurance refused to cover. Altogether, I owe $1800, which I can’t afford. My father told me to ignore it, saying I don’t need to pay. I’m worried about how this will affect my credit. What should I do?
You mentioned paying your copay, but do you have an unpaid deductible? I work in medical billing and that’s a common issue.
Zayn said:
You mentioned paying your copay, but do you have an unpaid deductible? I work in medical billing and that’s a common issue.
No, my deductible was already covered for both visits.
@Kendall
Thanks for clarifying! I’d still recommend calling your insurance to find out why the claim was denied. If you can’t pay in full, try setting up a payment plan with the hospital. Future-you will thank you for avoiding collections!
@Zayn
Insurance companies often revise claims after a year or two. They might’ve overpaid earlier and are now taking it back.
@Kendall
Did you check if your care was in-network? Also, plans often have an out-of-pocket max separate from deductibles.
I’m a lawyer (but not your lawyer). If this visit happened after January 1, 2022, the No Surprises Act might apply. This law stops hospitals from charging out-of-network fees in emergencies.
If the hospital is in-network, they should honor the fee schedule. If it’s out-of-network, you only owe your in-network copay/deductible. The rest is between the hospital and insurance.
Check your explanation of benefits to see why this happened. If the hospital is balance billing you illegally, you can file a complaint with the Centers for Medicare and Medicaid Services. Here’s the link for that: CMS Complaint Form.
@Ash
This happened on 9/2/2023. I was visiting Key West but live in NJ. The hospital claims insurance withdrew payment because I supposedly have another primary insurance, but I don’t. I’m confused.
Kendall said:
@Ash
This happened on 9/2/2023. I was visiting Key West but live in NJ. The hospital claims insurance withdrew payment because I supposedly have another primary insurance, but I don’t. I’m confused.
Are you sure you’re not on a parent’s insurance or have coverage through work? If not, call your insurance to confirm. Tell them you don’t have any other coverage and request a coordination of benefits. You should also ask the hospital about financial assistance programs—they might reduce or cancel your bill.
@Freddie
The insurance now says my coverage ended months earlier than my college told me. The procedure happened after they claim my coverage ended. I’m 21 and trying to sort out this mess.
@Ash
Does this law also apply to ambulance rides? I took two in 2023, and they weren’t in-network.
Ember said:
@Ash
Does this law also apply to ambulance rides? I took two in 2023, and they weren’t in-network.
The No Surprises Act doesn’t cover ambulances, but some states have laws that do. Check the laws in both Arizona (where you live) and Washington (where the incident happened).
@Ash
Thanks. I’ll look into it. It’s confusing trying to figure out which state’s rules apply.
@Ash
I worked in medical collections for years and didn’t know about this law—thanks for sharing. This is why it’s better to talk to a lawyer than random people online.
Which insurance company is this? I’ve heard ER visits are usually covered no matter the insurance type, but I could be wrong. Maybe the insurer is at fault here. It’s worth double-checking.
Mack said:
Which insurance company is this? I’ve heard ER visits are usually covered no matter the insurance type, but I could be wrong. Maybe the insurer is at fault here. It’s worth double-checking.
Blue Cross.
Mack said:
Which insurance company is this? I’ve heard ER visits are usually covered no matter the insurance type, but I could be wrong. Maybe the insurer is at fault here. It’s worth double-checking.
ER visits can still come with big out-of-pocket costs, like flat fees or percentages not covered by insurance. Hospitals do send bills to collections if you don’t work something out. It’s better to negotiate and set up a payment plan.
Here in the US, medical debt above $1000 can hit your credit after a year if unpaid. If it’s less than $1000, it won’t. I had a similar situation with ambulance bills. Medical debt piles up fast if left unaddressed.
@Ember
Do you have a source for the $1000 threshold?