- My Forums
- Tiger Rant
- LSU Recruiting
- SEC Rant
- Saints Talk
- Pelicans Talk
- More Sports Board
- Fantasy Sports
- Golf Board
- Soccer Board
- O-T Lounge
- Tech Board
- Home/Garden Board
- Outdoor Board
- Health/Fitness Board
- Movie/TV Board
- Book Board
- Music Board
- Political Talk
- Money Talk
- Fark Board
- Gaming Board
- Travel Board
- Food/Drink Board
- Ticket Exchange
- TD Help Board
Customize My Forums- View All Forums
- Show Left Links
- Topic Sort Options
- Trending Topics
- Recent Topics
- Active Topics
Started By
Message
Medical Billing - “Network Discount”
Posted on 10/23/23 at 1:48 pm
Posted on 10/23/23 at 1:48 pm
I'm seeking some clarity regarding a medical billing issue I'm experiencing. Here are the key details:
- The claim is with a healthcare provider that is out of network.
-On my Explanation of Benefits, there's a column titled "Cigna Network Discount". This column aligns with the remaining balance that the provider is billing me for, after I paid what I was initially informed was my responsibility.
- I attempted to appeal this with Cigna, but their response was that they paid what they determined to be appropriate.
I'm a bit confused and would appreciate any insights or advice from those familiar with medical billing and insurance policies.
1. Can someone help me understand the significance of the "Cigna Network Discount" column? Especially if the provider isn’t in network? Is this just a pressure tactic for the provider to accept a lesser amount?
2. Why might there be a discrepancy between what I was initially informed to pay and the remaining balance billed by the provider?
3. Is there any recourse for me in this situation? Since this was an ambulance and I didn’t have a choice of an in network provider I thought I’d be covered under the No Surprise Act, but they conveniently left out road ambulances to be covered.
Appreciate any insight!
- The claim is with a healthcare provider that is out of network.
-On my Explanation of Benefits, there's a column titled "Cigna Network Discount". This column aligns with the remaining balance that the provider is billing me for, after I paid what I was initially informed was my responsibility.
- I attempted to appeal this with Cigna, but their response was that they paid what they determined to be appropriate.
I'm a bit confused and would appreciate any insights or advice from those familiar with medical billing and insurance policies.
1. Can someone help me understand the significance of the "Cigna Network Discount" column? Especially if the provider isn’t in network? Is this just a pressure tactic for the provider to accept a lesser amount?
2. Why might there be a discrepancy between what I was initially informed to pay and the remaining balance billed by the provider?
3. Is there any recourse for me in this situation? Since this was an ambulance and I didn’t have a choice of an in network provider I thought I’d be covered under the No Surprise Act, but they conveniently left out road ambulances to be covered.
Appreciate any insight!
This post was edited on 10/23/23 at 1:49 pm
3
Posted on 10/23/23 at 2:14 pm to Lazy But Talented
quote:
Why might there be a discrepancy between what I was initially informed to pay and the remaining balance billed by the provider?
Because health insurance is the biggest shite show in the western world. Seriously.
We have a high deductible plan and they still cant get it right between our provider’s billing department and the insurance company. We often have credits and then random debits that we have to pay. I reconcile it with EOBs but it’s a disaster- and the worst part is that it’s all by design. There are billions of dollars in profit that are designed to make the transaction between provider and patient as painful as possible.
Posted on 10/23/23 at 2:33 pm to Lazy But Talented
quote:
1. Can someone help me understand the significance of the "Cigna Network Discount" column?
This is probably for in network discounts for a provider being in network. I think the alignment with the balance is just poor placement.
quote:
2. Why might there be a discrepancy between what I was initially informed to pay and the remaining balance billed by the provider?
when you were initially informed to pay, was it on a piece of paper that says "This is not a bill" and may change? It is likely an estimate of services versus coverage until the claim is processed.
quote:
3. Is there any recourse for me in this situation? Since this was an ambulance and I didn’t have a choice of an in network provider I thought I’d be covered under the No Surprise Act, but they conveniently left out road ambulances to be covered.
You can negotiate the balance owed to the provider with the provider. I am sure Cigna has policies in place for appeals to appeal their part of things.
As a side, Ambulances like to be out of networks so that they can bill the remainder to the patient. Because of the nature of the service, few people can argue with them.
If in network providers are charging you above the the contracted metwork/provider agreement, the may be engaged in "Balance billing", which is illegal in Louisiana. You may be in TX?
This post was edited on 10/23/23 at 3:05 pm
Posted on 10/23/23 at 2:38 pm to Motorboat
quote:
This is probably for in network discounts for a provider being in network. I think the alignment with the balance is just poor placement.
I agree with this and think the alignment is the thing that makes things look funky. If this was an in-network provider, you wouldn't owe this amount. Because they are out of network with Cigna, there's no discount applied on the claim.
I would reach out to the ambulance service to discuss payment and see if you can set up a discounted price with them.
Posted on 10/23/23 at 3:02 pm to WuShock
quote:
I would reach out to the ambulance service to discuss payment and see if you can set up a discounted price with them.
I tried on the phone a couple times. All outsourced to India and can't actually speak to anyone that can answer questions. They were able to put my account on hold while the disputed/challenged the payment with Cigna. Cigna said they paid all they are willing to pay.
You also can't speak to anyone with knowledge at Cigna either. All outsourced that just read off the EOB that I can do myself.
This post was edited on 10/23/23 at 3:09 pm
Posted on 10/23/23 at 3:06 pm to Motorboat
quote:
when you were initially informed to pay, was it on a piece of paper that says "This is not a bill" and may change? It is likely an estimate of services versus coverage until the claim is processed.
The original invoice from the provider was $277. This matched what Cigna stated was my responsibility to pay. I paid the $277 to the provider. Then the provider revised the invoice a few weeks later to be $2064. Which is the amount Cigna has listed as the "Network Discount." From my assumption, the Provider was expecting Cigna to pay that amount and Cigna decided not to or was unable to negotiate the bill down?
quote:
If in network providers are charging you above the the contracted metwork/provider agreement, the may be engaged in "Balance billing", which is illegal in Louisiana. You may be in TX?
It's illegal here too in TX I believe, but since it was out of network. I have no protection. The only protection for out-of-network claims would be with the No Surprises Act. Which conveniently excludes road ambulances (Does include air ambulances - neat).
This post was edited on 10/23/23 at 3:11 pm
Posted on 10/23/23 at 3:13 pm to Lazy But Talented
Thanks for the responses, everyone. Sounds like Cigna made an error on the EOB and shouldn't have listed an amoutn that was a part of a Cigna Network Discount since the proider was out of network.
Man medical billing is messy and that doesn't even take into account how outrageous of a bill it is to give an IV and transfer someone 5 miles in an ambulance.
Man medical billing is messy and that doesn't even take into account how outrageous of a bill it is to give an IV and transfer someone 5 miles in an ambulance.
This post was edited on 10/23/23 at 3:18 pm
Posted on 10/24/23 at 11:54 am to Lazy But Talented
quote:
Man medical billing is messy and that doesn't even take into account how outrageous of a bill it is to give an IV and transfer someone 5 miles in an ambulance.
$2500 +?
Page 1 of 1
Popular
Back to top
Follow TigerDroppings for LSU Football News