Recent Visit to the Emergency Room

Well...not so recent as I am late in keeping up with updating our BLOG.

Back in August I had cut my finger with a knife when I was packing up my apartment.  There was no to much pain but a whole lot of bleeding.  After 20 min of continuous bleeding I decide to visit the Emergency Room (ER) as it was during the middle of the night.

Living in the Gold Coast I chose to visit St. Joseph's which is Resurrection HealthCare.  I was treated right away and during my 45 minute stay I received gel foam to help coagulate the blood on the cut, which was wrapped up with a band-aid.  I was then visited by a physician who went over the gel foam and told me to keep it on for 24 hours and then let it heal naturally.

Two weeks following my visit I received a bill from Resurrection HealthCare for $1072.50 which was for Facility Emergency Services.  The next day I received another bill, this time for Physician Services which was for $196.  This brought my total bill to $1,268.50.

$1,268.50 is the retail cost and is the cost one would be responsible to pay if not covered by health insurance.

Being self-employed I have private health insurance coverage with Blue Cross and Blue Shield of Illinois (BCBSIL), in which I presented my insurance card at time of service.  The plan I have is HSA compatible with an annual $2,600 deductible then 100% coverage after. My plan design leaves me to pay up to the my deductible before BCBSIL is to pay a percentage or all.

Back to the bills....

Once I received all billing from Resurrection I then received two Explanation of Benefits (EOBs) from BCBSIL that went over my recent visit, costs and then showed the allowable amount I was to be billed for these services.  The "allowable amount" also known as the "negotiated/contracted rate" is the amount the provider (Resurrection) is allowed to bill me since they accept BCBSIL and are considered an "in-network" provider.

Another week went by and I then received updated billing from Resurrection requesting the reflected amount on my EOBs.  This final amount is what I owe to the provider and is applied towards my deductible.

The final costs were $521 for Facility Services and $56 for Physician Services, $577 total. This is how health insurance works! 

No matter what my plan benefits are compared to anyone else with BCBSIL this would be the plan members responsibility prior to their plan benefits.

Now....the final thing to discuss is how the plan design of my HSA compatible plan works.  The plan requires that I meet the first $2,600 before BCBSIL is to pay 100% of all remaining calendar year expenses.  I take a monthly medication that costs $46 each time at Walgreens, totaling $552/year that is applied toward my deductible.  With the above ER expense I have applied a total of $1,129 toward the plan deductible.  This leaves me knowing that if anything major happened to me, I would only owe a remaining $1,471 before BCBSIL is to pay 100%.  For the price I pay in premium, I don't find a high deductible plan of coverage without copays to be too bad.

Hope this helps in making a decision towards purchasing a plan or understanding how a plan of coverage works.

Thanks,

-The Shoppe