Filing an Insurance Claim
Intermediate English listening exercise ยท Health Insurance
Transcript
[Agent] Thank you for calling MediCare Plus. How can I help you today? [Caller] Hi, I had an emergency room visit two weeks ago and I received a bill for four thousand dollars. I thought my insurance would cover it. [Agent] I'm sorry about the confusion. Let me look into that for you. Can I have your member ID number? [Caller] It's MCP-78432. [Agent] Thank you. I can see your ER visit on January fifteenth. It appears the claim was denied because the hospital submitted it as an out-of-network provider. [Caller] But it was an emergency! I didn't have time to check which hospital was in-network. [Agent] You're absolutely right, and that's an important point. Under the No Surprises Act, emergency services must be covered at in-network rates regardless of which hospital you go to. This looks like a billing error. [Caller] So what happens now? [Agent] I'm going to reprocess the claim as an in-network emergency visit. Your emergency room copay is two hundred and fifty dollars, and then your plan covers the rest at eighty percent after your deductible. [Caller] I've already met my deductible for the year. [Agent] Perfect. Then your total responsibility should be two hundred fifty dollars for the copay, plus twenty percent of the remaining balance. I'll have the corrected explanation of benefits mailed to you within five business days. [Caller] Will the hospital stop sending me collection notices? [Agent] I'll contact the hospital's billing department directly to let them know the claim is being reprocessed. In the meantime, don't pay the four-thousand-dollar bill. [Caller] Thank you so much. This is such a relief.
Comprehension questions
- Why was the insurance claim denied?
- What law protects patients from surprise ER bills?
- What is the date of the emergency room visit mentioned in the conversation?
- What is the caller's member ID number?
- What is the caller's emergency room copay amount?