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  • Allowed Amount Greater Than Billed Amount

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    Old 03-16-2015, 03:59 AM   #1
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    Allowed Amount Greater Than Billed Amount

    I am, fairly, new to this forum and I just want to ask for any opinion from anyone. My son, recently, had gone through EKG in a hospital. I was surprised when I got the bill. I had to pay $1,109.12 for just the EKG. I know it costs more in a hospital but the thing is, the hospital's billed amount is just $180.75 based on the COB. I talked to the customer service representative and she told me that this is due to the allowed amount, $964.25, being greater than the billed amount. I don't know if that makes sense. The hospital just billed my insurance, which is United Healthcare, for $180.75, but because my plan's allowed amount is $964.25, I have to pay $1,109.12. It appears that I have to pay the sum of the billed and allowed amount. Is this a usual practice of health insurance companies? Any advice will be helpful. Thank you.

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    Old 03-16-2015, 08:21 PM   #2
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    Re: Allowed Amount Greater Than Billed Amount

    Nope, not the usual practice, sounds like a bogus explanation. I would not pay it, read your benefit certificate to find out coverage and benefits, file an appeal with the ins co, file a complaint with the state dept of insurance and send a copy to the hospital. If push comes to shove and this unfair clause is actually the way your plan is written, you can negotiate with the hospital for a lower amount and payment plan.

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