17.5 Order of Bill Deduction

When applying medical bills to the deductibleThe amount of health care expenses an insured person is required to incur before benefits are payable under a health insurance plan., start with the earliest service date. If more than one bill has the same service date, use the bill with the highest amount first, then the next highest and so on down to the lowest bill with that same service date.

17.5.1 Hospital Bills

Hospitals do not always itemize the cost of their services according to the day and time of day the patient received the services. It is sometimes difficult to know when the patient met the deductible.

For this reason, if the patient’s hospital bill for one continuous stay in the hospital is equal to or above the deductible amount on the date of admission, the first day of admission is the date of service for the entire bill. The hospital bill is applied to the deductible first before counting any other medical costs that were incurred during the hospital stay.

Example 1

Linda submits a $2,000 bill toward her deductible, for hospitalization from July 12 through July 14. She also submits a physician bill for $2,500 with a date of service of July 12. Apply the $2,000 hospital bill to the deductible first.

17.5.2 Pregnancy Fees

Many providers charge a flat fee for pregnancy related services. The single fee includes all prenatal care, office visits, delivery, and postnatal care.

The entire "global” pregnancy fee is counted as an expense as of the date an agreement was signed.

This page last updated in Release Number: 07-01
Release Date: 10/29/07
Effective Date: 02/01/08

The information concerning the BadgerCare Plus program provided in this handbook release is published in accordance with: Titles XI, XIX and XXI of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapter 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2 and 101 through 109 of the Wisconsin Administrative Code.

Notice: The content within this manual is the sole responsibility of the State of Wisconsin's Department of Health Services (DHS). This site will link to sites outside of DHS where appropriate. DHS is in no way responsible for the content of sites outside of DHS.

Publication Number: P-10171