Quote:
Originally Posted by scrubbs
Hopeless;
Prior to being on Medicare, I was covered by two different providers over a 40 year period. Both providers had provisions that they would only pay reasonable and customary charges. That meant that any provider would agree to accept that amount or refuse service if they charged more. "Or I could pay the difference."
I was never asked to pay the difference.
When I received my explanation of benefits it would state, Amount charged, 125,
amount paid by my insurance, $75, amount due, $0.
I hope, for everybody having to go through this frightening experience "allowed amount" means reasonable and customary charges and will be treated the same.
scrubbs
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Hi Scrubbs,
I hope you are correct that things will remain the same. Things have changed drastically since I worked in the health insurance industry several decades ago. Under many plans, especially HMO's, PPO's, POS, etc. there are
negotiated fees and providers accept the negotiated fee. U and C of long ago did not work the same way as negotiated fees of today.
When it comes to insurance industry terminology, one needs to be VERY careful to know how it is defined and exactly what it means.
Last week I received something in the mail from an insurance company with a minor change in terminology, just ONE word changed and it made a HUGE difference in the amount I would be responsible to pay out of my pocket. It was very sutle and could have easily been overlooked.
I just want people to be aware that things are not always as they appear. Even when we "think" we understand what is meant, the insurer may have a very different meaning than what meets the eye. I just want people to be careful. KNOW what you are getting and what all the terminology means before diving in.
You made a very good point but my past experience makes me wary of not knowing EXACTLY what the terminology means and how it is defined by the insurer. Different insurers may also use the same terminology but have differing definitions for the same term.