Non Contracting Hospital visit for Emergency

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Karrine

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Hello

Im hoping someone has experienced this and may be able to give some advice. In January of this year I went to the nearest ER for a severe asthma attack. I provided my insurance card upon entering. I was admitted into the hospital as they discovered I also had pneumonia and they couldnt regulate my breathing. I ended up staying in the hospital for 3 days. I was not aware I was in a non-participating hospital.

A few weeks later I received a bill for 21,000.00. from the hospital. Obviously alarmed as my max out of pocket is 4000, I called the insurance company. I was then informed that "someone at the hospital made a mistake and that I should have been transferred to a participating provider" and that I should file a grievance.

Im going to try to make this as short as possible...My issue is, it was a emergency. I had no choice but to locate the nearest facility. I do not understand why Im being penalized for this. So I did file a grievance and the insurance company approved a partial amount (7000). They are stating the hospital is billing above and beyond what is customary and according to the American medical association, and they will not pay it. So my balance is roughly 14,000.00....The hospital keeps sending these bills, along with several others (for treatments received while admitted). When I talk to the hospital they say Anthem needs to pay, when I speak to Anthem they say I need to pay.

This hospital (Prime healthcare) was sued this year and had to pay 1.2 million dollars for something called "balance billing". But I dont even fully understand if that is relevant to my situation.

Im at a loss as what to do or who to ask for help. Im more than happy to pay my max out of pocket for non-contracting provider fees, but I feel like something is very wrong with what happened.

Any advice is appreciated, thank you.
 
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