Legal Question in Insurance Law in Georgia

I don't understand Blue Cross's explanations of benefits.

Had some surgery done. Total charges were $24252.70. Under ''amount not covered'' it reads zero. There is a column entitled ''Discount''. Here, the amount reads, $16432.70. Next to that there is a column entitled ''Why''. The letter A is in this column. Down at the bottom of the page, under reasons why, after the letter A it reads: This amount reflects charges exceeding the allowed amount and is not the responsibility of the patient. I don't understand this. Actual benefits paid were $6256.00. Thanks for your time!


Asked on 1/29/02, 5:58 am

1 Answer from Attorneys
Lori Jolly COMMANDER + POUND, LLP

Re: I don't understand Blue Cross's explanations of benefits.

Explanation of benefits (EOB)language can be very confusing. Basically, what the quoted language means is that BCBS, your insurer, and the hospital/medical provider have reached an agreement on the costs that the insurer will pay for any given type of surgery/treatment. Only people who are covered by BCBS recieve the benefit of the BCBS negotiated amount. You are not responsible for the remaining $16,000+. Beware, the hospital may bill you anyway, and you should kindly call them and explain that you have recevied your EOB stating that you are not responsible for the difference.

It is a strange set-up, but the hospital recieves the benefit of guaranteed payment up to a certain amount and that BCBS patients will use their facility. Most insurance companies have similar setups with hospitals/providers.

Read more
Answered on 2/01/02, 2:56 pm


Related Questions & Answers

More Insurance Law questions and answers in Georgia