Amy,

I have one question about insurance - Is it possible for a patient to find out the "correct" contracted charge of the service he/she received.

The reason I asked this question is that I have received different charges for the same service. I had 20 hyperbaric oxygen treatments early this year, for the final 10 treatments, the statement from the insurance company showed a much higher contracted charge than the initial 10 treatments, although the hospital has claimed same amount for all 20 treatments. Because of this increase of contracted charge, my resonsibily also increased considerably for the final 10 treatments.

I called insurance questioning why I had different charge for the same treatment. Spent more than a hour on the phone with the representative, she reviewed all the original claims from the hospital and told me that the hospital has filed everything OK, the last 10 treatments were incorrectly coded by the insurance and they will adjust(lower) the statements.

One month later, realizing that no adjustment has been made, I called again and I was told that as a matter of fact the charge for the final 10 treatments were correct, it was the the charge for the initial 10 treatments that were wrong. The representative indicated that the mistake was due to an "old" provider contract.

For us as patient, is there anyway to find out what the contracted charge should be for a particular service ? Is this information confidential ? Do we simply pay whatever the insurance company said, or there is a way to verify ? What about insurance company made mistake on the charges, how do we find out ?


Sorry for the long post, thank you very much for your help.