Negative Insurance Discount with United Health Care and Sentara

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almostretired1965
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Negative Insurance Discount with United Health Care and Sentara

Post by almostretired1965 » Tue Aug 14, 2018 9:34 am

So I just got something that feels like a scam to me, even if it is indeed legal. My wife had a routine periodic chest x-ray done to check for TB. Sentara billed the insurance company $184 for the procedure so you would think that would be my maximum liability under the deductible. But no, apparently, the contracted amount is $380, so they applied a negative discount and say I need to pay $380.

This is first time I have ever seen this. Am I stuck paying for this or is there something I can do about it. Any thoughts or suggestions would be much appreciated.

Rupert
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Re: Negative Insurance Discount with United Health Care and Sentara

Post by Rupert » Tue Aug 14, 2018 9:38 am

Have you asked your insurance company how much you owe the provider? That's what I would do first.

$380 for a chest xray would be bonkers, so does that number also include the amount charged by a doctor to read the xray?

almostretired1965
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Re: Negative Insurance Discount with United Health Care and Sentara

Post by almostretired1965 » Tue Aug 14, 2018 9:40 am

Yes. The insurance company is who explained the negative discount to me. I thought for sure it must have been an error.

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HueyLD
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Re: Negative Insurance Discount with United Health Care and Sentara

Post by HueyLD » Tue Aug 14, 2018 11:35 am

Let me take a guess.

How many charges are on the EOB? There should be a few lines of charges and the negative discount that appears to apply to one line may actually be the cumulative adjustment for all lines.

Just a guess.

RudyS
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Re: Negative Insurance Discount with United Health Care and Sentara

Post by RudyS » Tue Aug 14, 2018 8:56 pm

If the contracted amount is $380, I do not understand why UHC isn't paying it. Seems you need to escalate this at UHC.

Jack FFR1846
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Re: Negative Insurance Discount with United Health Care and Sentara

Post by Jack FFR1846 » Tue Aug 14, 2018 8:59 pm

RudyS wrote:
Tue Aug 14, 2018 8:56 pm
If the contracted amount is $380, I do not understand why UHC isn't paying it. Seems you need to escalate this at UHC.
Deductible not yet met?
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mouses
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Re: Negative Insurance Discount with United Health Care and Sentara

Post by mouses » Tue Aug 14, 2018 9:03 pm

What's a negative discount?

almostretired1965
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Re: Negative Insurance Discount with United Health Care and Sentara

Post by almostretired1965 » Wed Aug 15, 2018 2:23 pm

Jack FFR1846 wrote:
Tue Aug 14, 2018 8:59 pm
RudyS wrote:
Tue Aug 14, 2018 8:56 pm
If the contracted amount is $380, I do not understand why UHC isn't paying it. Seems you need to escalate this at UHC.
Deductible not yet met?
Exactly. I have a high deductible plan.

almostretired1965
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Re: Negative Insurance Discount with United Health Care and Sentara

Post by almostretired1965 » Wed Aug 15, 2018 2:28 pm

mouses wrote:
Tue Aug 14, 2018 9:03 pm
What's a negative discount?
Normally, the contracted amount between the insurance company and the provider is less than the sticker price. That has been the case with every other procedure I have ever had. In this case however, supposedly, the contracted amount is double the sticker price. So instead of a regular, positive discount, it's negative. And according to Sentara and UHC, I need to pay the contracted amount (out of pocket since I have not reached my deductible).

As I said, this may be the way it is, but I find it utterly ridiculous.

almostretired1965
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Re: Negative Insurance Discount with United Health Care and Sentara

Post by almostretired1965 » Wed Aug 15, 2018 2:33 pm

HueyLD wrote:
Tue Aug 14, 2018 11:35 am
Let me take a guess.

How many charges are on the EOB? There should be a few lines of charges and the negative discount that appears to apply to one line may actually be the cumulative adjustment for all lines.

Just a guess.
That's not it. The only other line on the EOB is for a mammogram done at the same time (which is covered for free under ACA).

SlowMovingInvestor
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Re: Negative Insurance Discount with United Health Care and Sentara

Post by SlowMovingInvestor » Wed Aug 15, 2018 2:36 pm

almostretired1965 wrote:
Wed Aug 15, 2018 2:28 pm
mouses wrote:
Tue Aug 14, 2018 9:03 pm
What's a negative discount?
Normally, the contracted amount between the insurance company and the provider is less than the sticker price. That has been the case with every other procedure I have ever had. In this case however, supposedly, the contracted amount is double the sticker price. So instead of a regular, positive discount, it's negative. And according to Sentara and UHC, I need to pay the contracted amount (out of pocket since I have not reached my deductible).

As I said, this may be the way it is, but I find it utterly ridiculous.
Can you tell them -- I don't want the insurance ? I just want to pay cash. It wouldn't count to your deductible, but other than that, it would cost less.

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dm200
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Re: Negative Insurance Discount with United Health Care and Sentara

Post by dm200 » Wed Aug 15, 2018 4:58 pm

almostretired1965 wrote:
Tue Aug 14, 2018 9:34 am
So I just got something that feels like a scam to me, even if it is indeed legal. My wife had a routine periodic chest x-ray done to check for TB. Sentara billed the insurance company $184 for the procedure so you would think that would be my maximum liability under the deductible. But no, apparently, the contracted amount is $380, so they applied a negative discount and say I need to pay $380.
This is first time I have ever seen this. Am I stuck paying for this or is there something I can do about it. Any thoughts or suggestions would be much appreciated.
Bizarre indeed! Sure seems that the "contracted amount" and the "amount billed" to the insurance company should be the same. This sure sounds like there is more to the story..

What is "Sentara" and their role? Who gets the extra money?

JBTX
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Re: Negative Insurance Discount with United Health Care and Sentara

Post by JBTX » Wed Aug 15, 2018 5:31 pm

SlowMovingInvestor wrote:
Wed Aug 15, 2018 2:36 pm
almostretired1965 wrote:
Wed Aug 15, 2018 2:28 pm
mouses wrote:
Tue Aug 14, 2018 9:03 pm
What's a negative discount?
Normally, the contracted amount between the insurance company and the provider is less than the sticker price. That has been the case with every other procedure I have ever had. In this case however, supposedly, the contracted amount is double the sticker price. So instead of a regular, positive discount, it's negative. And according to Sentara and UHC, I need to pay the contracted amount (out of pocket since I have not reached my deductible).

As I said, this may be the way it is, but I find it utterly ridiculous.
Can you tell them -- I don't want the insurance ? I just want to pay cash. It wouldn't count to your deductible, but other than that, it would cost less.
This.

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neurosphere
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Re: Negative Insurance Discount with United Health Care and Sentara

Post by neurosphere » Wed Aug 15, 2018 6:20 pm

I'm not an expert, but when you signed up for insurance you agreed to pay the contracted rate. It's indeed strange that the amount you were billed is less than the rate, but the law requires you pay the rate you agreed to when you accepted to be covered by insurance.

I think it's possible, but am not sure, that you can simply choose not to submit the cost through your insurance, and pay the billed rate. This amount won't go towards your deductible, however, if you have one. I have done this with medications which had a $30 co-pay through insurance, but the cash price at the pharmacy was $7.

One thing to watch out for regarding the x-ray. Is the cost for the image itself or for the radiologist to read it or both?

SlowMovingInvestor
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Re: Negative Insurance Discount with United Health Care and Sentara

Post by SlowMovingInvestor » Wed Aug 15, 2018 6:43 pm

Also, is TB screening covered under the ACA ? If covered, it should be free.

almostretired1965
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Re: Negative Insurance Discount with United Health Care and Sentara

Post by almostretired1965 » Thu Aug 16, 2018 7:47 am

neurosphere wrote:
Wed Aug 15, 2018 6:20 pm
I'm not an expert, but when you signed up for insurance you agreed to pay the contracted rate. It's indeed strange that the amount you were billed is less than the rate, but the law requires you pay the rate you agreed to when you accepted to be covered by insurance.

I think it's possible, but am not sure, that you can simply choose not to submit the cost through your insurance, and pay the billed rate. This amount won't go towards your deductible, however, if you have one. I have done this with medications which had a $30 co-pay through insurance, but the cash price at the pharmacy was $7.

One thing to watch out for regarding the x-ray. Is the cost for the image itself or for the radiologist to read it or both?
Had not thought of that. I will call and ask if the insurance claim can be reversed. Worth trying at least. We will be way under the deductible this year unless something catastrophic happens in the next 2 months.

Thanks,

An-Jen

almostretired1965
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Re: Negative Insurance Discount with United Health Care and Sentara

Post by almostretired1965 » Thu Aug 16, 2018 1:33 pm

almostretired1965 wrote:
Thu Aug 16, 2018 7:47 am
neurosphere wrote:
Wed Aug 15, 2018 6:20 pm
I'm not an expert, but when you signed up for insurance you agreed to pay the contracted rate. It's indeed strange that the amount you were billed is less than the rate, but the law requires you pay the rate you agreed to when you accepted to be covered by insurance.

I think it's possible, but am not sure, that you can simply choose not to submit the cost through your insurance, and pay the billed rate. This amount won't go towards your deductible, however, if you have one. I have done this with medications which had a $30 co-pay through insurance, but the cash price at the pharmacy was $7.

One thing to watch out for regarding the x-ray. Is the cost for the image itself or for the radiologist to read it or both?
Had not thought of that. I will call and ask if the insurance claim can be reversed. Worth trying at least. We will be way under the deductible this year unless something catastrophic happens in the next 2 months.

Thanks,

An-Jen
I called customer service and had it escalated to a supervisor, but Sentara was singularly unhelpful. No use wasting more time on this. I will pay the bill and never do business with this company ever again. If anyone has any suggestions for good government or consumer websites besides Yelp where I can document my complaint, I'd appreciate a pointer.

almostretired1965
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Re: Negative Insurance Discount with United Health Care and Sentara

Post by almostretired1965 » Thu Aug 16, 2018 1:34 pm

SlowMovingInvestor wrote:
Wed Aug 15, 2018 6:43 pm
Also, is TB screening covered under the ACA ? If covered, it should be free.
I don't think it comes under one of the "freebies" like an annual physical, etc.

almostretired1965
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Re: Negative Insurance Discount with United Health Care and Sentara

Post by almostretired1965 » Thu Aug 16, 2018 1:41 pm

dm200 wrote:
Wed Aug 15, 2018 4:58 pm
almostretired1965 wrote:
Tue Aug 14, 2018 9:34 am
So I just got something that feels like a scam to me, even if it is indeed legal. My wife had a routine periodic chest x-ray done to check for TB. Sentara billed the insurance company $184 for the procedure so you would think that would be my maximum liability under the deductible. But no, apparently, the contracted amount is $380, so they applied a negative discount and say I need to pay $380.
This is first time I have ever seen this. Am I stuck paying for this or is there something I can do about it. Any thoughts or suggestions would be much appreciated.
Bizarre indeed! Sure seems that the "contracted amount" and the "amount billed" to the insurance company should be the same. This sure sounds like there is more to the story..

What is "Sentara" and their role? Who gets the extra money?
The amount billed is the list price so it has, for me until this episode, always been higher than the contracted amount. Sentara is the healthcare provider.

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dm200
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Re: Negative Insurance Discount with United Health Care and Sentara

Post by dm200 » Thu Aug 16, 2018 1:47 pm

almostretired1965 wrote:
Thu Aug 16, 2018 1:41 pm
dm200 wrote:
Wed Aug 15, 2018 4:58 pm
almostretired1965 wrote:
Tue Aug 14, 2018 9:34 am
So I just got something that feels like a scam to me, even if it is indeed legal. My wife had a routine periodic chest x-ray done to check for TB. Sentara billed the insurance company $184 for the procedure so you would think that would be my maximum liability under the deductible. But no, apparently, the contracted amount is $380, so they applied a negative discount and say I need to pay $380.
This is first time I have ever seen this. Am I stuck paying for this or is there something I can do about it. Any thoughts or suggestions would be much appreciated.
Bizarre indeed! Sure seems that the "contracted amount" and the "amount billed" to the insurance company should be the same. This sure sounds like there is more to the story..
What is "Sentara" and their role? Who gets the extra money?
The amount billed is the list price so it has, for me until this episode, always been higher than the contracted amount. Sentara is the healthcare provider.
Never saw or heard about anything like this. The use of the term "negative discount" is creative. More accurately, seems like a surcharge of penalty.

In my experience, health insurance companies put folks on the call line that know very little. On one or two occasions when I got this kind of nonsense, I called and pushed very, very hard to talk with someone who knew the whole story.

MrBeaver
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Re: Negative Insurance Discount with United Health Care and Sentara

Post by MrBeaver » Thu Aug 16, 2018 1:51 pm

almostretired1965 wrote:
Thu Aug 16, 2018 1:33 pm
If anyone has any suggestions for good government or consumer websites besides Yelp where I can document my complaint, I'd appreciate a pointer.
In this order, I would:
  1. Call your state department of insurance and find out what is legal. If you find the bahavior is not allowed, file a complaint.
  2. Send a letter to the hospital/medical group administrator stating that you are unhappy with their billing practices and therefore will be choosing other providers in the future.
  3. Call your congressman and ask for a sit-down with a congressional aid. Explain the situation and ask what can be done. If your congressman happens to be Gallagher(WI), Torres(CA), Sanford(SC), Krishnamoorthi(IL), DeSantis(FL), Perlmutter(CO), Green(TX), or Burgess (TX), you are in luck as they have sponsored unsuccessful legislation in the past which would require more pricing transparency than there is today. If you had pricing transparency, you wouldn’t be in this predicament in the first place as you would have asked for the cash price at the time of service when they asked you whether you wanted to pay $X through insurance or <$X as a cash customer.

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neurosphere
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Re: Negative Insurance Discount with United Health Care and Sentara

Post by neurosphere » Thu Aug 16, 2018 1:52 pm

dm200 wrote:
Thu Aug 16, 2018 1:47 pm
Never saw or heard about anything like this. The use of the term "negative discount" is creative. More accurately, seems like a surcharge of penalty.
I don't understand why an insurance company would ALLOW a reimbursement/charge which is less than what the actual rate was.

I'm wondering if the billed charge was the negotiated rate for another insurance (e.g. Medicaid or medicare) rather than the cash rate, billed by mistake. But then when the submitted code went to the insurance company, the correct negotiated rate was charged.

Medicaid pays my employer $29 for a service which other insurances pay $150, for example.

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dm200
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Re: Negative Insurance Discount with United Health Care and Sentara

Post by dm200 » Thu Aug 16, 2018 1:55 pm

neurosphere wrote:
Thu Aug 16, 2018 1:52 pm
dm200 wrote:
Thu Aug 16, 2018 1:47 pm
Never saw or heard about anything like this. The use of the term "negative discount" is creative. More accurately, seems like a surcharge of penalty.
I don't understand why an insurance company would ALLOW a reimbursement/charge which is less than what the actual rate was.
I'm wondering if the billed charge was the negotiated rate for another insurance (e.g. Medicaid or medicare) rather than the cash rate, billed by mistake. But then when the submitted code went to the insurance company, the correct negotiated rate was charged.
Medicaid pays my employer $29 for a service which other insurances pay $150, for example.
This sounds to me like either:

1. A clerical mistake and an ill-informed person who explained it; OR

2. Some other completely different added information

My guess is #1

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neurosphere
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Re: Negative Insurance Discount with United Health Care and Sentara

Post by neurosphere » Thu Aug 16, 2018 1:55 pm

I'm wondering if the OP can post ALL the information from the EOB, that is, each line/column and column heading and the amounts. These EOBs can be quite confusing at times, and perhaps this is just a misunderstanding?
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Dottie57
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Re: Negative Insurance Discount with United Health Care and Sentara

Post by Dottie57 » Thu Aug 16, 2018 3:09 pm

I would send this info to the appropriate state agency which handle health plans. It sounds crooked. Maybe also your Congress person and senators. To me this is a big deal. You should not have to pay more than originally billled.

The whole purpose of coverage is to negotiate lower costs.

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dm200
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Re: Negative Insurance Discount with United Health Care and Sentara

Post by dm200 » Thu Aug 16, 2018 3:57 pm

Dottie57 wrote:
Thu Aug 16, 2018 3:09 pm
I would send this info to the appropriate state agency which handle health plans. It sounds crooked. Maybe also your Congress person and senators. To me this is a big deal. You should not have to pay more than originally billled.
The whole purpose of coverage is to negotiate lower costs.
Maybe, but I suspect clerical error and incompetence.

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Re: Negative Insurance Discount with United Health Care and Sentara

Post by Dottie57 » Thu Aug 16, 2018 4:09 pm

dm200 wrote:
Thu Aug 16, 2018 3:57 pm
Dottie57 wrote:
Thu Aug 16, 2018 3:09 pm
I would send this info to the appropriate state agency which handle health plans. It sounds crooked. Maybe also your Congress person and senators. To me this is a big deal. You should not have to pay more than originally billled.
The whole purpose of coverage is to negotiate lower costs.
Maybe, but I suspect clerical error and incompetence.
My suggestions are for help and to let government know a new twist of negative discount.

Dottie57
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Re: Negative Insurance Discount with United Health Care and Sentara

Post by Dottie57 » Thu Aug 16, 2018 4:14 pm

neurosphere wrote:
Wed Aug 15, 2018 6:20 pm
I'm not an expert, but when you signed up for insurance you agreed to pay the contracted rate. It's indeed strange that the amount you were billed is less than the rate, but the law requires you pay the rate you agreed to when you accepted to be covered by insurance.

I think it's possible, but am not sure, that you can simply choose not to submit the cost through your insurance, and pay the billed rate. This amount won't go towards your deductible, however, if you have one. I have done this with medications which had a $30 co-pay through insurance, but the cash price at the pharmacy was $7.

One thing to watch out for regarding the x-ray. Is the cost for the image itself or for the radiologist to read it or both?
I am sure that I did not sign anything for health insurance when employed. I simply clicked on the plan I desired.

WillRetire
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Re: Negative Insurance Discount with United Health Care and Sentara

Post by WillRetire » Thu Aug 16, 2018 4:25 pm

OP:

Something similar happened to me. Medical facility billed $200. Insurance company raised it to $400, because that is the contracted rate for that procedure at that medical facility.

I switched medical facilities where the contracted rates with the insurance company are much much better, and the problem has not repeated.

tmcc
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Re: Negative Insurance Discount with United Health Care and Sentara

Post by tmcc » Thu Aug 16, 2018 5:54 pm

almostretired1965 wrote:
Tue Aug 14, 2018 9:34 am
So I just got something that feels like a scam to me, even if it is indeed legal. My wife had a routine periodic chest x-ray done to check for TB. Sentara billed the insurance company $184 for the procedure so you would think that would be my maximum liability under the deductible. But no, apparently, the contracted amount is $380, so they applied a negative discount and say I need to pay $380.

This is first time I have ever seen this. Am I stuck paying for this or is there something I can do about it. Any thoughts or suggestions would be much appreciated.
billed charge caps should prevent the contracted amount from exceeding reimbursement. sentara messed up big time in their charge master. appeal it and tell them you're going to write a letter to the AG on being overcharged.

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dm200
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Re: Negative Insurance Discount with United Health Care and Sentara

Post by dm200 » Fri Aug 17, 2018 1:47 pm

Is it possible this is an in vs out of network issue? Or confusion about that??

Having the normal provider and insurance the same nearly eliminates this problem for us.

SimonJester
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Re: Negative Insurance Discount with United Health Care and Sentara

Post by SimonJester » Sat Aug 18, 2018 8:43 am

My wife has had the same thing with a CT scan, cash rate was $190, insurance rate $400ish. We are on a high deductible plan and would have had to cover the $400, so we paid cash. As others pointed out the $190 would not count towards your deductible.
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Dottie57
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Re: Negative Insurance Discount with United Health Care and Sentara

Post by Dottie57 » Sat Aug 18, 2018 9:22 am

SimonJester wrote:
Sat Aug 18, 2018 8:43 am
My wife has had the same thing with a CT scan, cash rate was $190, insurance rate $400ish. We are on a high deductible plan and would have had to cover the $400, so we paid cash. As others pointed out the $190 would not count towards your deductible.
Are you sure the provider was in network? Out of net work will only get paid X, you are responsible for the rest.

WillRetire
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Re: Negative Insurance Discount with United Health Care and Sentara

Post by WillRetire » Sat Aug 18, 2018 11:44 am

Dottie57 wrote:
Sat Aug 18, 2018 9:22 am
SimonJester wrote:
Sat Aug 18, 2018 8:43 am
My wife has had the same thing with a CT scan, cash rate was $190, insurance rate $400ish. We are on a high deductible plan and would have had to cover the $400, so we paid cash. As others pointed out the $190 would not count towards your deductible.
Are you sure the provider was in network? Out of net work will only get paid X, you are responsible for the rest.
OP can confirm but probable answer is "yes" in-network; otherwise there is no such thing as "contracted amount" (generally; there are some exceptions). This was the case for me too. Basically, the medical facility (Sentara in Op's case), billed an amount less than they were contractually allowed. UHC processes the claim, and says basically, the medical facility should have billed the contracted amount, and tells the patient to pay accordingly.

Bottom line: Sentara has very high contract amounts with UHC for some procedures, and the consumer pays for it. Where possible, get a price quote in advance from myuhc for non-emergency treatment, and check which facilities are cheaper.

Sentara is in-network but not cheap. UHC and other insurers want to have large networks. A consequence of this is some in-network providers are very expensive. I.e. In-network providers have separate contracts with the insurance company. This is why a given procedure's price differs across in-network providers even within the same city or metro area.

bberris
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Re: Negative Insurance Discount with United Health Care and Sentara

Post by bberris » Sat Aug 18, 2018 11:57 am

mouses wrote:
Tue Aug 14, 2018 9:03 pm
What's a negative discount?
A kickback.

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celia
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Re: Negative Insurance Discount with United Health Care and Sentara

Post by celia » Sat Aug 18, 2018 12:48 pm

What if Sentara (the service provider) had billed your insurance $380 and insurance said it was not medically necessary (which could be the case here). If the insurance would have paid the contracted price, you may not have owed anything. But since they didn't pay, you owe it.

Had that happened, would you have just paid the $380?

This sounds like the service provided didn't fall within the range of services covered by the contract between UH and Sentara or it wasn't medically necessary or wasn't long enough since the last xray for TB.


I am running across cases like this as Medicare is clamping down on what lab work and procedures are covered. A relative had a work up before surgery this year and a lot of it was denied by Medicare as not medically necessary. For another relative, a doctor recently wrote orders for 9 lab tests, but after we questioned that many, they canceled 4 of them since they were done recently by a different doctor. Another lab wouldn't be covered since the code for medical necessity wasn't given. So the patient had 4 tests done at the lab and paid upfront for the "unknown necessity" at a different lab upstairs in the same building. The upfront cost, with no insurance being billed, was less than half of what Medicare would have paid. I've also had several labs done recently by paying 1/4 or 1/3 up front with no-one being billed afterwards.

My guess is that the higher cost when any insurance is involved is for the administration/paperwork involved. After all, both parties have to track the billed amount, answer your phone calls, re-bill, send you a statement, process payment from the insurer and/or you, send something to collections, etc. These things aren't free, so have to be worked into the price of the labwork or procedure. So if you want the lowest cash price, I would think you need to pay it up front, not after they have expended all the time in processing the claim. Why would they accept just the contract amount when they have incurred additional costs since the service was provided?

I'm sorry if this sounds harsh, but you are not the only one experiencing it. Since I've ended up putting in hours on other rejected claims, maybe my experience will help you and others. My philosophy is now changing to just pay the small amount up front instead of spending my time and more money later on. But it starts with the billing codes that will be used and a phone call.

So, I suggest you cut your losses and move on. Don't waste any more time on this as you've already done.

WillRetire
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Re: Negative Insurance Discount with United Health Care and Sentara

Post by WillRetire » Sat Aug 18, 2018 1:05 pm

celia wrote:
Sat Aug 18, 2018 12:48 pm
What if Sentara (the service provider) had billed your insurance $380 and insurance said it was not medically necessary (which could be the case here). If the insurance would have paid the contracted price, you may not have owed anything. But since they didn't pay, you owe it.

Had that happened, would you have just paid the $380?

This sounds like the service provided didn't fall within the range of services covered by the contract between UH and Sentara or it wasn't medically necessary or wasn't long enough since the last xray for TB.
Celia, No. If this is anything like what happened to me, the procedure was covered, and the (higher) contracted amount counts towards the deductible. The original poster can verify this from the EOB.

I know it is difficult for people to comprehend, but sometimes the contracted rate is just darn high. Why Sentara submits a rate that is lower than the contracted rate, I do not know. I/T bug? Medical facilities are not known for brilliant I/T systems.

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celia
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Re: Negative Insurance Discount with United Health Care and Sentara

Post by celia » Sat Aug 18, 2018 1:31 pm

WillRetire wrote:
Sat Aug 18, 2018 1:05 pm
celia wrote:
Sat Aug 18, 2018 12:48 pm
This sounds like the service provided didn't fall within the range of services covered by the contract between UH and Sentara or it wasn't medically necessary or wasn't long enough since the last xray for TB.
Celia, No. If this is anything like what happened to me, the procedure was covered, and the (higher) contracted amount counts towards the deductible. The original poster can verify this from the EOB.
OK. Let me change my statement to:
This sounds like the service provided didn't fall within the range of services covered by the contract between UH and Sentara or the deductible wasn't yet been met or it wasn't medically necessary or wasn't long enough since the last xray for TB.
.
almostretired1965 wrote:
Tue Aug 14, 2018 9:34 am
Sentara billed the insurance company $184 for the procedure so you would think that would be my maximum liability under the deductible. But no, apparently, the contracted amount is $380, so they applied a negative discount and say I need to pay $380.
The problem appears to be that the OP is now expecting to pay only $184, as if he was the one who had a "contract" with Sentara. That likely could have been possible if he had paid that much up front without any insurance being billed. But if he had done that and later had big medical bills, he would still have to pay that part of the deductible again that he avoided.

Dottie57
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Joined: Thu May 19, 2016 5:43 pm

Re: Negative Insurance Discount with United Health Care and Sentara

Post by Dottie57 » Sat Aug 18, 2018 1:51 pm

The best thing OP could do is post the EOB with all of the lines in it.

It is all a guessing game since we don’t have the whole picture.

bjorka7769
Posts: 30
Joined: Wed Feb 28, 2007 4:42 pm
Location: Des Moines, IA

Re: Negative Insurance Discount with United Health Care and Sentara

Post by bjorka7769 » Sat Aug 18, 2018 2:07 pm

I had this happen in 2012. I had a CVS (early amnio) done with a subset of microarray testing done. I couldn't reconcile the EOBs to the hospital bill. I finally figured out that UCR of my primary insurance on my procedure was higher than retail so the hospital adjusted it up on one of the line items. I'd never seen anything like it, guess it's more common. Bill was adjusted up a few thousand. My husband was starting a new job, so I was on COBRA and his new insurance by the time we could get baby to cooperate in-utero for procedure (took 3 times to try). I had no OOP since both insurances paid in on it. Medical billing was my PT job back then since I was high risk in 3 different ways. My blood thinner injections were switched to brand-name from generics due to a cost-sharing agreement with the new insurance. Weird times.

SimonJester
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Joined: Tue Aug 16, 2011 12:39 pm

Re: Negative Insurance Discount with United Health Care and Sentara

Post by SimonJester » Sun Aug 19, 2018 10:16 am

Dottie57 wrote:
Sat Aug 18, 2018 9:22 am
SimonJester wrote:
Sat Aug 18, 2018 8:43 am
My wife has had the same thing with a CT scan, cash rate was $190, insurance rate $400ish. We are on a high deductible plan and would have had to cover the $400, so we paid cash. As others pointed out the $190 would not count towards your deductible.
Are you sure the provider was in network? Out of net work will only get paid X, you are responsible for the rest.
Yes our was 100% in-network. Also for this procedure it required pre authorization, which is when we found out the insurance cost vs cash. Insurance eventually also denied the procedure due to my wife's age (too young). In the end we paid cash, so there was no EOB...
"They who can give up essential liberty to obtain a little temporary safety, deserve neither liberty nor safety." - Benjamin Franklin

almostretired1965
Posts: 26
Joined: Mon Nov 13, 2017 2:02 pm

Re: Negative Insurance Discount with United Health Care and Sentara

Post by almostretired1965 » Sat Aug 25, 2018 1:00 pm

celia wrote:
Sat Aug 18, 2018 1:31 pm
WillRetire wrote:
Sat Aug 18, 2018 1:05 pm
celia wrote:
Sat Aug 18, 2018 12:48 pm
This sounds like the service provided didn't fall within the range of services covered by the contract between UH and Sentara or it wasn't medically necessary or wasn't long enough since the last xray for TB.
Celia, No. If this is anything like what happened to me, the procedure was covered, and the (higher) contracted amount counts towards the deductible. The original poster can verify this from the EOB.
OK. Let me change my statement to:
This sounds like the service provided didn't fall within the range of services covered by the contract between UH and Sentara or the deductible wasn't yet been met or it wasn't medically necessary or wasn't long enough since the last xray for TB.
.
almostretired1965 wrote:
Tue Aug 14, 2018 9:34 am
Sentara billed the insurance company $184 for the procedure so you would think that would be my maximum liability under the deductible. But no, apparently, the contracted amount is $380, so they applied a negative discount and say I need to pay $380.
The problem appears to be that the OP is now expecting to pay only $184, as if he was the one who had a "contract" with Sentara. That likely could have been possible if he had paid that much up front without any insurance being billed. But if he had done that and later had big medical bills, he would still have to pay that part of the deductible again that he avoided.
That is exactly what I expected and it is exactly what would have happened if my wife had asked to be billed directly without submitting it to insurance. But as you know, transparency in pricing is what the American healthcare system is all about.

Now granted, my expectation is in line with what I consider to be common sense. The fact that they call it a "negative" discount and not surcharge should tell you something. At the very least I should be allowed to pay it without going through insurance, but near as I can tell, there is no simple way for me to get things reversed.

User avatar
Joe S.
Posts: 479
Joined: Sat May 05, 2007 12:11 pm

Re: Negative Insurance Discount with United Health Care and Sentara

Post by Joe S. » Sun Aug 26, 2018 1:40 pm

My understanding is that if Sentara (the hospital) agreed to give United Health Care a discount, that should be given to all United Health Care policyholders whether they have met their deductible or not.

This seems to be the case from the government website:

https://www.healthcare.gov/why-coverage ... eductible/

If you do a google search on this subject, do not look for "negative insurance discount." Technically speaking, they failed to give you the discount they should have given you, rather than charged a "negative discount."

https://www.npr.org/sections/health-sho ... a-discount

I suspect Sentara screwed up.

You could try calling your Sentara "patient advocate."

https://www.sentara.com/patientguide/yo ... cates.aspx

I work part time in a Radiology office, but I am not an expert on Insurance.

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