But if you go through insurance, they will pay their percentage and your portion will be credited to your out of pocket total. This would help with future charges
The only time I’d advise not using insurance is if you’re getting treatment on December 31st and it’s cheaper to pay out of pocket—because your deductible/OOP resets on January 1st. If you haven’t met your deductible yet, paying cash might cost less than having the claim go through insurance and count toward a deductible that’s about to reset anyway. That said, this only applies if you’re allowed to opt out, which isn’t common with in-network providers, since they’re typically required to bill your insurance. All other times, you accumulate towards your deductible/OOP max and will pay less for the rest of the year.
You need to have it submitted to your insurance so that they can apply your benefits. If you don’t they are never going to know that you had the ER visit.
Help me understand why you wouldn’t have the hospital submit the claim?
I've been reading about many accounts of the base bill increasing significantly after going through insurance, and I'm worried that 1) they decide since it wasn't necessary they won't pay it 2) the bill (after inflation) will go up so much that even with the benefits tacked on, it'll surpass the self pay costs.
I won't know for sure until I submit but it's jist nerve-wracking to cross the bridge...
The only reason that is is because allowed amount > self pay rate & you haven’t met your deductible so you owe the full allowed amount. In any case, this counts towards your calendar year cost shares and you will pay less later on.
I see your point. With the negotiated rate, it may make your bill go up as self-pay could be cheaper. But once you give them your insurance info, it’s only whatever your EOB says you pay and there’s no going back.
I think insurance may be a larger bill. However, do you want what you pay to apply towards your remaining out of pocket maximum for this benefit period?
If the hospital is in-network, the negotiated prices should be "reasonable". What you do have to worry about, is what the deadline is for them to submit charges for in-network. It could be as low as 60 days. The billing department at the hospital should have a good feel for what they get paid by your insurance.
Have you gotten the doctor bill yet? It's going to be difficult to have one paid by insurance and the other as self-pay.
OP, if you want to compare the numbers side by side, then email/DM your insurer and ask them what their negotiated rates are with this provider for the CPT codes on your bill.
Given that your remaining OOP max is about 3200, it’s quite likely that once you submit this claim, you will meet your OOP max; which means any additional covered medical services will be free.
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u/Brilliant-Apricot423 Jun 17 '25
But if you go through insurance, they will pay their percentage and your portion will be credited to your out of pocket total. This would help with future charges