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Insurance won't cover man's $20k hospital bill due to policy terminology

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BATON ROUGE - David Santini was on his way home from work when he collapsed, suffering from internal bleeding.

After spending three days in the hospital, Santini went home to continue his recovery. Soon after, he received his explanation of benefits in the mail from his insurance company. That letter told him his emergency cost over $20,000 and that they weren't going to cover it.

"There was $1.42 that they did cover out of all of that," said Santini.

It was a shock for him and his family and it all boiled down to one word: observation. 

"There is this terminology that can make the difference between your insurance paying for major medical problems or not," explained Santini, "Observation they do not cover. If you're in the hospital for observation, my policy and many others I imagine, do not cover the cost."

Santini returned to the hospital to talk about the costs, but they stood firm. He also wrote several letters to his insurance company, Blue Cross and Blue Shield, but to no success. He only wishes someone would have told him about this and the financial differences associated with being admitted to the hospital.

"Advice I would give is to check your policy and see if there is a distinction between observation and inpatient care."

2 On Your Side was able to put Santini in touch with the right person at Our Lady of the Lake, who reduced his bill significantly.


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