I had a large claim filed (just over 8k). My understanding, and my hospitals, was that I would likely owe roughly 3k of that, which would put me at my deductible and out of pocket max for the year.

I just received my EOB, and BCBS is showing they paid it in full, despite me still being roughly 700 away from my deductible, and a couple grand away from my out of pocket max.

After speaking to my insurance, the rep had no explanation as to why it was considered at 100%. Is this something I should expect will be reviewed and I will still end up owing, or is this possibly something that was billed or processed under some random coverage in my policy?

histag10 said:

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I had a large claim filed (just over 8k). My understanding, and my hospitals, was that I would likely owe roughly 3k of that, which would put me at my deductible and out of pocket max for the year.

I just received my EOB, and BCBS is showing they paid it in full, despite me still being roughly 700 away from my deductible, and a couple grand away from my out of pocket max.

After speaking to my insurance, the rep had no explanation as to why it was considered at 100%. Is this something I should expect will be reviewed and I will still end up owing, or is this possibly something that was billed or processed under some random coverage in my policy?

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Be happy, but expect that they might come back and ask for your contribution.

Do you have an online login that allows you to check what portion of your deductible is still unmet? Also the online page sometimes goes into more detail on how the claim was processed and paid. Look into that, has helped me several times.

PincheDriller said:

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Do you have an online login that allows you to check what portion of your deductible is still unmet? Also the online page sometimes goes into more detail on how the claim was processed and paid. Look into that, has helped me several times.

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Yes, that's where I get my EOB and info. Showed I am 700ish away from deductible and roughly 2500 away from OOP max

The Wonderer said:

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histag10 said:

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I had a large claim filed (just over 8k). My understanding, and my hospitals, was that I would likely owe roughly 3k of that, which would put me at my deductible and out of pocket max for the year.

I just received my EOB, and BCBS is showing they paid it in full, despite me still being roughly 700 away from my deductible, and a couple grand away from my out of pocket max.

After speaking to my insurance, the rep had no explanation as to why it was considered at 100%. Is this something I should expect will be reviewed and I will still end up owing, or is this possibly something that was billed or processed under some random coverage in my policy?

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Be happy, but expect that they might come back and ask for your contribution.

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That's what I was afraid of...

Hoping it stays as is

12 months from now you will likely receive a bill from BCBS telling you to politely bend over.

I've dealt with those pleasant surprises too often to believe them anymore. As others said, expect them to come back and ask for the money in several months.

That's what I was afraid of. It was traumatic enough to not be expecting it, and I just don't want to be caught off guard and relive the whole thing with a massive bill in a few months. Guess I should just prepare for it.

The advice given and taken is wise.

I had a similar thing happen twice to me. The only difference is that I paid what I owed, and then they said I paid too much and refunded me $1500.

I know I didn't pay too much. I was keeping track of it meticulously. A year goes by after the refund, and they send me another $1500. I know they screwed up and I told them so. My total deductible back then was $2500.

They never did come back and ask for the money and that was 10 years ago.

Review your summary of benefits. Your employer can provide you it or it should be on the website. It goes into what they cover and how much they cover towards a procedure.

For example my benefits state that any lab test performed in patient is not covered and is subject to deductible but if I get the same test at an outpatient in network lab it's covered at 100%.

PincheDriller said:

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Review your summary of benefits. Your employer can provide you it or it should be on the website. It goes into what they cover and how much they cover towards a procedure.

For example my benefits state that any lab test performed in patient is not covered and is subject to deductible but if I get the same test at an outpatient in network lab it's covered at 100%.

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It was an unexpected surgery billed under maternity. From everything I can find, it should be subject to my deductible and OOP Max, as the majority of maternity procedures and labs are, with the exception of a few. I logically cannot find any reason my insurance would have covered this at 100%, nor can I find any insurance that would cover this procedure at 100% without the deductible at least having been met. Some that I have seen dont cover it at all.

Holy Schmoly! So insurance pushed the claim through a different department to reevaluate it and reprocess it, since it seems so odd that it paid it in full.

New claim statement has come back with a zero balance as well.

I'll take this as a win, and move on with my life.

No help here but I can't believe ANYONE currently knows WTF is going on in health insurance.

IslandAg76 said:

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No help here but I can't believe ANYONE currently knows WTF is going on in health insurance.

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QFT

Expect they will correct it at review but it might work in your favor. I had a situation in my favor years ago. Insurance entered a bill that I actually paid $35 as me having paid $3500 toward my deductible. OOPS! After a round and round with the insco to attempt to get it corrected, I gave up after wasting about 5 hours of my own time. That was 5 years ago... We had plenty of other charges that year as my wife had a C-section. All paid by insurance...

CJS4715 said:

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Expect they will correct it at review but it might work in your favor. I had a situation in my favor years ago. Insurance entered a bill that I actually paid $35 as me having paid $3500 toward my deductible. OOPS! After a round and round with the insco to attempt to get it corrected, I gave up after wasting about 5 hours of my own time. That was 5 years ago... We had plenty of other charges that year as my wife had a C-section. All paid by insurance...

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Review came back as paid in full as well.

Now that I think about it, I didn't pay for my c-section a few years ago either. Just the anesthesiologist and a few other things, but not the surgery or stay

Leave it alone. Their algorithm says they should pay so they did and their lazy employee probably didn't feel like filling out the paperwork to correct it. Why fight it?

BCBS can go jump a rope... glad someone benefited from their billing interpretation.