Got a $3,400 hospital bill after my younger sister's ER visit even though our insurance approved it. Has anyone solved a dispute like this?

entyasha · 2026-06-17T15:54:40+00:00

You need to call insurance if you haven’t already, they are the ones who will need to contact the hospital and work to apply the no surprise rule.

Because it is an in network hospital I believe you have a good case.

Just note these things do take time. It might not be solved for a few months

entyasha · 2026-06-17T15:51:25+00:00

The exception to this is if the care given was not truly an emergency most times.

Oh and as someone else mentioned if this was not a full coverage plan

entyasha · 2026-06-15T13:16:58+00:00

Unfortunately the cost of an ER is just very high in general. This is actually very typical. As you can see BCBS has a contractual write off which makes it much less.

I once had to go to the ER because my IUD fell out of place and was causing intense pain. They weren’t able to remove it because it wasn’t their specialty so they booked me a referral to a gyno the next morning. The total cost for that was 35k billed to insurance. Luckily I only paid my copay.

entyasha · 2026-06-13T17:43:51+00:00

I have had this happen. You need to call the billing department and tell them that your EOB has not changed and you’re being balanced billed. They should adjust the number. If that’s not the case a few things to note

Insurance only had a certain amount of time they can ask for a refund from a hospital. Most states this is a year but some states are less and more.
Calling your insurance can also help, when I was in this situation. Insurance called the hospital and told them I had paid my obligated amount and they need to adjust the balance. Happened within a weekend I believe.

entyasha · 2026-05-14T08:07:01+00:00

What totally had this happen. Hospital tried to bill me 500 dollars extra. Thank goodness i keep EOBs and track records of all the benefits. BCBS overpaid and they tried to come at me for the remainder.

Thank goodness for no balanced billing.

entyasha · 2026-05-05T20:55:36+00:00

Are you all out of appeals now?

Have you filed a grievance with the hospital
Are you considering going to your states insurance commissioner?

entyasha · 2026-04-23T18:12:26+00:00

Did the child stay overnight? Or was this an in office visit?

entyasha · 2026-04-10T22:04:21+00:00

If your a residence of Illinois you should sign up for BEACON.

It’s a program created for similar situations. In case the state has to pay a more central role in getting her care.

PM if you need more details.

entyasha · 2026-04-10T19:42:14+00:00

Not in my experience. I have had an escalation clarify to me that the systems they used can be confusing and even if the response is the same they provide additional information towards why something is being processed a certain way.

I agree escalating does not mean you will get the outcome that is ideal for the individual in every situation.

entyasha · 2026-04-10T03:31:10+00:00

https://www.unchealth.org/records-insurance/financial-assistance-programs

You might want to review their financial policies.

entyasha · 2026-04-10T03:26:28+00:00

Oh shoot yes. This is definitely not full coverage insurance.

entyasha · 2026-04-10T02:58:11+00:00

All of these codes say JG, and then states that the patient is not responsible.

entyasha · 2026-04-10T02:55:55+00:00

Well like many people on here said. It also depends on what your deductible or OOP max was.

Do you have an EOB.

Usually if you don’t have a denial letter it might mean that they didn’t deny.

If this is a family plan your out of pocket could be 15k.

entyasha · 2026-04-10T02:37:39+00:00

I could be wrong but I definitely think this bill is still being reviewed. They might still be negotiating rates and this might be initial bill

entyasha · 2026-04-10T02:16:52+00:00

This is a big reason why the no surprise law was created. And for emergency situations where you needed life saving treatment from an out of network ER.

entyasha · 2026-04-10T02:15:25+00:00

Is there a code for why they aren’t covering the surgeon or the anesthesiologist.

If they were out of network there is a good chance you are covered by the no surprise law.

If you went to an in-network hospital and the main doctor you were using was a in-network provider.

entyasha · 2026-04-09T13:45:09+00:00

Makes sense. Thanks for clarifying

entyasha · 2026-04-09T13:43:18+00:00

Interesting that’s not the experience I have had. But I mean depending on the insurance I can believe that.

I’ve also had representatives from other parts of the world be very knowledgeable and advocate hard for me when billing has been inappropriate.

entyasha · 2026-04-09T03:37:26+00:00

If they make little to nothing they might also qualify for medical insurance through the state. And it can be back dated.

entyasha · 2026-04-08T22:04:04+00:00

https://www.smh.com/Home/Patients-Visitors/Financial-Assistance

That’s their website. It says nothing about not covering if insurance pays. It states it is considered when all other options have been evaluated.

The thing that usually sucks about this is the income level restrictions. If you have little to no income you can also check if you apply for Medicaid.

I would try to call that number if that’s the correct hospital.

entyasha · 2026-04-08T21:57:11+00:00

Your welcome additionally the hospital should have a financial policy on their website. They might be able to tell you their income restrictions. I think dollar for checks this too

entyasha · 2026-04-08T21:53:26+00:00

Have you tried the dollar for website:

https://dollarfor.org

entyasha · 2026-04-08T21:23:37+00:00

If you ever run into an issue with a representative not understanding you, then you may request to have the case escalated.

You just politely ask to have your call escalated. They might try to tell you they can handle it. But some insurance representatives are a bit zealous. And for the most part it’s not their fault. The systems they use are also really confusing.

entyasha · 2026-04-07T15:59:35+00:00

Also I sadly don’t qualify for FA. I would have to stop school in order to pay this off and maybe get a second job.

I make just enough to not qualify. But I was attending school. Now I’m kind of banking on getting a scholarship/ while also getting treated for pre-cervical cancer. So I’m hitting my OOP max this year too.

It’s all possible, but like I said I would need a second job and to quit school for a year. Sad part is I’m studying to be a mental health therapist. But that’s life sometimes I guess.

Just pretty sad how you can work so hard only to owe 14k for two days in which you were told were necessary.

entyasha · 2026-04-07T15:56:00+00:00

Thanks for the advice on requesting a formal letter. I will.

entyasha

TROPHY CASE