How does a health insurance work?


I got a mail from my health insurance that shows that i claimed $600 but it also shows that the same amount is ineligible? What does it mean? Does it mean that i have to pay it?SERIOUS ANSWERS Only pls

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Answers:
The paper from your insurance company (the Explanation of Benefits or EOB) should have codes on the line item to explain why the charge is ineligible. It could be something as simple as the provider sent in a duplicate claim in error, didn't provide the correct coding information on the claim, or that medical record review is required. You would not have to pay for anything.
But, it could be that the services is not a covered benefit under your policy, your deductible is not met, or your policy was terminated.
Check the EOB for more info or call the 800 number listed and a rep can explain. Usually there is also a part of the EOB that says "what you owe". That will help you know whether you are responsible too.

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Other Answers:

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The reasonable thing to do would be to call your insurance company. They can explain it better to you than anyone on here could.

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It means they will not pay the $600 claim.I would speculate you should check your deductible!

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!~ 1st they.. oh wait. you said serious answer..so too bad ~! (>_<)

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call the company and ask them. find out why it's "ineligible". sometimes, medical offices code things incorrectly and sometimes they insurance company just tries to get out of paying

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It's possible that you have not yet met your deductible which would make you responsible for paying the amount due. It's also possible that that procedure required prior authorization which was not recieved. If that's the case, then you can either try to get a retroactive authorization or you could still be held responsible for the charges. Best bet is to call your insurance carrier and ask them to explain the charges and why it was considered ineligible. They can advise you as to your best course of action from there. Good luck!

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Call them..But I think if you go to a doc that takes your insurance then all you have to pay is your co-pay. Usally let say your visit cost $100 but your insurance only allows $80 for a visit. Your doc has to eat the $20.00 b/c they agree to take your insurance. All you have to pay is your co-pay.


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