r/HospitalBills • u/dunderthecovers • Apr 18 '25

Hospital-Non Emergency Additional Hospital Bill *Confused*

Hi all,

Forgive me, as I am having trouble wrapping my head around this one. I am covered by Anthem Blue Shield and went to Mount Sinai in NYC to have my leg looked at from a knee injury. Two visits. Each time they charged me $75 at the physician's office and said that's all I would need to cover and Anthem would do the rest. A few weeks later and I am now getting billed an additional $360 per visit. I called Mount Sinai and they said this is an "outpatient facility charge" which is separate from the physician's office charge. Is this normal? I was under the impression my insurance would cover the rest of my visit. If anyone recognizes this and can clear it up for me I would gladly appreciate it! (screenshot of the bill summary is attached).

6 Upvotes

100% Upvoted

17 comments sorted by

View all comments

0

u/breezin80 Apr 18 '25

Why are they balance billing you? If they are in network you only owe the amount Anthem allows minus any payment Anthem made.

1

u/Known_Paramedic_9503 Apr 20 '25

It depends on if you have a yearly deductible

3

u/breezin80 Apr 20 '25

Deductibles are included in the allowed amount. Unless the provider is out of network, the insured is only responsible for the amount allowed by the insurance. Insurance payment + deductible/copay/coinsurance = allowed amount.