Yeah, not an exciting topic but I was hoping someone might have some advice for me.
Last April, I collapsed at work and was taken by ambulance to the hospital. The closest hospital to my job also happens to be the most expensive hospital in the city. Thankfully, I recovered fine but am still paying for more expensive tests and looking for a diagnosis.
Anyway, I got the enormous bill a few months later and with help from my parents, paid everything and closed the books on it. Three months ago, out of the blue, I got another statement from my insurance company. When I called them wondering why I was still getting billed, they explained that the hospital had misfiled one of the costs and had sent my insurance a new bill which has now trickled down to me. Its not a huge sum but its money I need since I was just referred to yet another specialist.
My feeling is that the hospital should eat their mistake. If this kind of behavior is allowable, what's to stop them from coming after me again a year from now claiming they'd undercharged for the ambulance? My plan is to call the hospital's billing department on Monday or Wednesday, but is there any chance I can get them to let me out of the new bill? Any advice for how to plead my case? I'm not a person who does well for conflict and the idea of asking for someone's supervisor in an angry customer voice, it just makes me feel dirty.
Posted by fugu13 (Member # 2859) on :
At the very least you should be able to force them to wait until you're ready to pay, though you might have to go on minimal installment payments.
Posted by mr_porteiro_head (Member # 4644) on :
Not that it helps you in your situation, but it might help to know that it sometimes happens the other way around. Last month we got a check from a hospital that we haven't been to in over five years. They claimed that they had overcharged us, and just now discovered the mistake.
Posted by CT (Member # 8342) on :
I don't know if you will get them to waive it, but you can almost certainly arrange for a very lenient payment plan -- even as low as $10-20/month, from what I've seen.
Posted by Scott R (Member # 567) on :
Hospital bills, and billing sucks. Our last two kids were both put in the NICU (for different reasons), and between the bungling hospital billing staff, and the bungling insurance billing staff it's a wonder we're still sane and solvent.
Thank goodness the doctors are exceptional.
Posted by Ron Lambert (Member # 2872) on :
At the very least, contact their customer service and talk to them, see what accommodation they might be able to offer, since it was their mistake. Try to be as pleasant and business-like as possible when you talk to them. Insult them or be sarcastic, and that will just get their backs up, and you won't get the consideration you otherwise might.
Posted by maui babe (Member # 1894) on :
quote:Originally posted by mr_porteiro_head: Not that it helps you in your situation, but it might help to know that it sometimes happens the other way around. Last month we got a check from a hospital that we haven't been to in over five years. They claimed that they had overcharged us, and just now discovered the mistake.
This happened to me too... I wonder if there's some kind of mandated auditing occurring?
Posted by theamazeeaz (Member # 6970) on :
Nothing stops them from coming back to you a year later. I had two sets of health insurance last year (one because I was under 23 at the time and covered through mom and dad, the other because I have my own insurance through my graduate school). Just last month and fully a year later I got a statement in the mail refusing the entire $14,000 appendicitis claim because I had two insurances and the card I gave the hospital was not the "primary", even though I gave the hospital both cards at the time, and they gave back the other! As far as I know, it's straightened out, but it was a major pain in the butt, and a waste of my time.
This is one of the reasons I'm a strong supporter of government-run health care in the sense that it takes the billing out of the hands of the patients. Everyone pays taxes, taxes pay hospital. People who need hospital use hospital. People who don't need hospital need it eventually or have loved ones who are helped by hospital. Health-care shouldn't be run by people who have a monetary incentive to get out of paying for every claim possible.
Anyway, I'll never forget the time my friend was bleeding from the head and screamed for the ambulance to go away because she didn't want to deal with the insurance company over pre-approval issues like had happened from a prior accident.
Anyway, I'm curious why the insurance company isn't paying at least part of that.
I hate how there is no cost awareness at the hospital's end either. For example, I suspected that I had appendicitis when I went to the hospital and I was sent from my school's doctor's office. Appendicitis is diagnosed by two ways- ultrasound or CT scan. One costs $600, the other $3000 dollars. Insurance covered it in my case, but guess which one the hospital used? I'm not sure if the equipment to do an ultrasound was unavailable, but in any case, I was within a very close drive of several hospitals.
Posted by Shanna (Member # 7900) on :
After my initial collapse, I went around to every employee I work with and told them they were not allowed to call an ambulance unless I stopped breathing. So now they just let lie on the ground until I fully come around, even if I'm in the middle of the sales floor.
The hospital costs alone boggle my mind. I can understand the costs of the doctors and the tests but I already had to fight with them once because they have two different pay scales for tests. A higher rate for someone who walks off the street and just randomly asks for an EKG. And a lower rate for someone like myself who collapsed, had trouble breathing, and was complaining of chest pains. Of course, my hospital charged me the higher rate as if I had asked for the test instead of my doctor.
The argument now is over what my insurance representative called the "door fee." Its basically the cost for someone to walk into the hospital even before they see a doctor or have any tests done. After the hospital's recalculation, this one fee costs more than what I was charged by my doctor, the ambulance, and the lab work COMBINED.
I understand a flat rate but it seems excessive to me.
Posted by Flying Fish (Member # 12032) on :
I second what Mr. Lambert said. It's human nature for the person on the other end of the phone to bend in your direction when you're pleasant.
Explain that the bill took a long time to get to you, that you thought your insurance was going to cover everything, that you have more medical bills on the horizon, that you're afraid of having to declare bankruptcy someday, and you could settle by paying -- oh, 25% or 30% of what they're asking -- if they will write of the rest and consider you paid in full.
They might resubmit the bill to your insurance.
They might settle (getting 25% is way better than the 0% they'd get if you go bankrupt).
They might say no.
If they do agree to settle you'll need it in writing that you are paid in full.
Posted by DDDaysh (Member # 9499) on :
I'm sorry. I know how frustrating that is. My son used to go to a pulmonologist that was billed through a hospital. They'd send out about fifteen copies of bills that had "DO NOT PAY" printed on them, and then all of a sudden a collection agency would be calling because you hadn't paid the bill. It used to drive me wacky!
Now I'm just fighting with insurance because they won't approve my son's new medication... you know, the one that actually WORKS. Grrr...
Posted by tt&t (Member # 5600) on :
Thank goodness for our (NZ) public health system. That all sounds horrible! Not that that really helps you at all. Insurance companies are not much fun at the best of times, never mind when it's your health involved.
Hospitals here are generally free. After reading the above, I'm feeling pretty lucky right now.
Posted by rmessg7 (Member # 12528) on :
I'm guessing this thread falls under "Culture?" Maybe this topic should have been brought up at a medical or medical insurance gripe forum.
Posted by King of Men (Member # 6684) on :
quote:Originally posted by rmessg7: I'm guessing this thread falls under "Culture?" Maybe this topic should have been brought up at a medical or medical insurance gripe forum.
No, it's actually under 'Films', as in "American health insurance sucks; film at eleven".
Seriously, this forum discusses anything whatsoever. Why don't you demonstrate that by making an introduction thread?
Posted by rivka (Member # 4859) on :
tt&t?!?
*pounce*
HEY!
*hugs*
Posted by rivka (Member # 4859) on :
quote:Originally posted by King of Men: Seriously, this forum discusses anything whatsoever. Why don't you demonstrate that by making an introduction thread?
Failing that, we can start one discussing rude newbies. Posted by Shanna (Member # 7900) on :
quote:Nothing stops them from coming back to you a year later. I had two sets of health insurance last year (one because I was under 23 at the time and covered through mom and dad, the other because I have my own insurance through my graduate school). Just last month and fully a year later I got a statement in the mail refusing the entire $14,000 appendicitis claim because I had two insurances and the card I gave the hospital was not the "primary", even though I gave the hospital both cards at the time, and they gave back the other!
The individuals who made the error, by wrongfully submitting the bill even after being given all the information, should take responsibility. They should be working with individuals to correct their mistake so that everything can be filed and paid as it should have been the first time. Customer service must mean nothing to these people. And sadly, it should as I've seen people drive an hour out of their way while running dangerous fevers or dealing with broken bones, just so they can avoid an incompetent hospital.
Seriously, how is this legal? I'm trying to imagine any other industry that could keep coming after an individual for more and more money on finalized transactions.
If I order a computer, and my bill comes out to be $1000 for all the parts I requested, then if I pay that amount our contract should be complete. Same goes if you're buying a latte or a house. You can't go back a year later and say "Oops, we didn't factor in the remodeled kitchen so you owe us another $10,000."
That's what bothers me most. They shouldn't be allowed to do this!
Its already terrifying because you're feeling especially vulnerable (sick or injured) and you're having services provided without knowing what they're going to cost or if you'll ever be able to afford them. I'm still feeling the pain of throwing two paychecks away on an MRI that came back perfectly clear but was required in order to see a neurologist (and there went another paycheck.)
Posted by advice for robots (Member # 2544) on :
Where's Slash to eat the newbie?
Posted by Valentine014 (Member # 5981) on :
If I am not mistaken, providers have a limited period of time to file their claims. I thought it was a year. I would contact your company and and ask them if they have a policy like that. I don't know what state you are in, but here is an article about those laws in Michigan.
quote: a "health professional and facility must bill a qualified health plan within 1 year after the date of service or date of discharge from the health facility."
So, the claim you just the bill for, you still have to pay, but their time is running out to find more things for you to pay for. If that is any comfort.
Posted by advice for robots (Member # 2544) on :
quote:Originally posted by Shanna:
quote:Nothing stops them from coming back to you a year later. I had two sets of health insurance last year (one because I was under 23 at the time and covered through mom and dad, the other because I have my own insurance through my graduate school). Just last month and fully a year later I got a statement in the mail refusing the entire $14,000 appendicitis claim because I had two insurances and the card I gave the hospital was not the "primary", even though I gave the hospital both cards at the time, and they gave back the other!
The individuals who made the error, by wrongfully submitting the bill even after being given all the information, should take responsibility. They should be working with individuals to correct their mistake so that everything can be filed and paid as it should have been the first time. Customer service must mean nothing to these people. And sadly, it should as I've seen people drive an hour out of their way while running dangerous fevers or dealing with broken bones, just so they can avoid an incompetent hospital.
Seriously, how is this legal? I'm trying to imagine any other industry that could keep coming after an individual for more and more money on finalized transactions.
If I order a computer, and my bill comes out to be $1000 for all the parts I requested, then if I pay that amount our contract should be complete. Same goes if you're buying a latte or a house. You can't go back a year later and say "Oops, we didn't factor in the remodeled kitchen so you owe us another $10,000."
That's what bothers me most. They shouldn't be allowed to do this!
Its already terrifying because you're feeling especially vulnerable (sick or injured) and you're having services provided without knowing what they're going to cost or if you'll ever be able to afford them. I'm still feeling the pain of throwing two paychecks away on an MRI that came back perfectly clear but was required in order to see a neurologist (and there went another paycheck.)
Too many companies handle things like billing in a way that absolves any one person of responsibility for mistakes. Someone calls in to complain and all the rep can do is repeat whatever info is on his or her screen. Customer service/billing reps rarely are paid well enough to take on a customer's case personally: hunting down an answer or taking "not ready" time to delve into the problem and resolve it. Usually, as soon as the customer is off the phone, their problem officially becomes the domain of whichever unlucky stiff answers next time the customer calls.
In my experience, the customer is almost always the one who has to track down the solution or push to speak to someone who can make decisions.
Posted by dkw (Member # 3264) on :
quote:Originally posted by DDDaysh: I'm sorry. I know how frustrating that is. My son used to go to a pulmonologist that was billed through a hospital. They'd send out about fifteen copies of bills that had "DO NOT PAY" printed on them, and then all of a sudden a collection agency would be calling because you hadn't paid the bill. It used to drive me wacky!
This.
Our previous insurance company took 6-9 months to process anything. We'd go directly from "Insurance pending . . .Do Not Pay" to "Your account is seriously past due." Sometimes both of those notices in one week.
Posted by Godric 2.0 (Member # 11443) on :
A few months ago my wife visited the emergency room for a pregnancy scare. She and the baby turned out fine (we're due April 9), and we waited and waited for the bill.
Finally, my wife called the hospital and we were 3 days away from being sent to collections. Apparently they never recorded our new address from the ID she provided the nurse in the emergency room.
We were that close to possibly damaging our credit score because of their mistake.
Posted by The Rabbit (Member # 671) on :
Shanna, The first thing I would do is to contact your insurance company. Tell them that you believe this in an improper charge since you didn't "walk in the door", you were brought in unconscious by an ambulance. Ask your insurance company if they can offer you support in contesting the bill. Then (depending on the outcome of your discussion with the insurace company) contact the hospital and tell them that you believe you have been incorrectly charged a "door fee" (just like you were charged the incorrect fee before). Ask whether it is standard procedure to charge this door fee to ER patients who arrive unconscious in an ambulance? Explain that this fee is higher than all the other charges for the visit combined politely ask that they justify the charge. Depending on their response, tell them you plan to formally contest the bill and that is illegal for them to report non-payment to creditors until your dispute is over the bill is settled.
If your insurance won't assist, you may want to see if there is a local ombudsman who can help you with making a formal protest.
Posted by tt&t (Member # 5600) on :
Hey rivka good to see ya!
Posted by imogen (Member # 5485) on :
quote:Originally posted by tt&t: Thank goodness for our (NZ) public health system. That all sounds horrible! Not that that really helps you at all. Insurance companies are not much fun at the best of times, never mind when it's your health involved.
Hospitals here are generally free. After reading the above, I'm feeling pretty lucky right now.
I know. I feel like I'm always the 'Hey, Universal Healthcare works guys. Really!' girl, but, um, it does.
I am horrified by the health care and hospital stories I read here. And as much as our (Australian) system is not perfect, I feel very lucky to have it.
Posted by theamazeeaz (Member # 6970) on :
quote:Originally posted by Shanna:
quote:Nothing stops them from coming back to you a year later. I had two sets of health insurance last year (one because I was under 23 at the time and covered through mom and dad, the other because I have my own insurance through my graduate school). Just last month and fully a year later I got a statement in the mail refusing the entire $14,000 appendicitis claim because I had two insurances and the card I gave the hospital was not the "primary", even though I gave the hospital both cards at the time, and they gave back the other!
The individuals who made the error, by wrongfully submitting the bill even after being given all the information, should take responsibility. They should be working with individuals to correct their mistake so that everything can be filed and paid as it should have been the first time. Customer service must mean nothing to these people. And sadly, it should as I've seen people drive an hour out of their way while running dangerous fevers or dealing with broken bones, just so they can avoid an incompetent hospital.
Seriously, how is this legal? I'm trying to imagine any other industry that could keep coming after an individual for more and more money on finalized transactions.
If I order a computer, and my bill comes out to be $1000 for all the parts I requested, then if I pay that amount our contract should be complete. Same goes if you're buying a latte or a house. You can't go back a year later and say "Oops, we didn't factor in the remodeled kitchen so you owe us another $10,000."
That's what bothers me most. They shouldn't be allowed to do this!
Its already terrifying because you're feeling especially vulnerable (sick or injured) and you're having services provided without knowing what they're going to cost or if you'll ever be able to afford them. I'm still feeling the pain of throwing two paychecks away on an MRI that came back perfectly clear but was required in order to see a neurologist (and there went another paycheck.)
It got sorted out in the end, after a few phone calls. I got something in the mail that says "Benefits are not available for this claim because your provider sent it to us after the claim filing deadline. However, you are not responsible for the payment of these charges." Anyway, I agree with The Rabbit about using the method of delivery to the hospital as argument against what you requested.
Posted by Shanna (Member # 7900) on :
Well, it took nearly four hours and almost a dozen phone calls, but I finally got some answers on what went wrong.
The first two hours were spent calling both the insurance company and the hospital billing department. The hospital blamed the insurance company claiming they had requested a refund of the original payment (made by both the insurance company and myself) in December, eight months after the treatment date. When I called the insurance company, two representatives could not find the claim in question, two representatives said the hospital returned the initial payments, and three representatives gave me three different explanations, none of which matched the original explanation given to me when I first called about the "this is not a bill" letter.
After nearly three hours of being super-nice and asking questions in the most polite way possible, I was beyond frustrated and quickly losing my calm. So I swallowed my pride and called my mom. I hate sending my mom after customer service people because she's been known to make people cry (a guy at a car rental service once told me "scary.") However, she's really experienced when it comes to dealing with medical billing having given birth to three kids, fought cancer, and put up with the insurance nonsense that comes with having a husband with MS and a son with diabetes.
So after many threats and somehow managing to get into a three-way call with the hospital and the insurance company at the same time, we got the real reason for the bill. Basically, my hospital in IN-NETWORK but my ER doctor was not. The hospital "kindly" informed us that the ER has a sign posted explaining that the current doctor on call may not accept insurance. As I was strapped to a gurney with an oxygen mask over my face and struggling to stay conscious, I guess I missed the small print. I was able to provide my insurance card during a moment of consciousness and yet nothing was said to me at the time or to my parents who showed up twenty minutes later.
Originally, the hospital billed the insurance company with everything listed as in-network. Insurance paid them, I paid them, all was well. Eight months later, the doctor finally realizes that he doesn't accept insurance and therefore should have been paid at a rate five times higher than what he received. He (and the reps for his group of fellow non-insurance-accepting jerks) came after my insurance company for the extra dough. Insurance company demanded a refund, refiled the claim, and then I was billed for my new remainder.
In the end, my mom insisted on paying the bill and in return, I'm going to pay for a few hotel nights during the family's summer vacation. I think the call ended with my mom making some threats of legal action if another bill is sent due to their error. Since my mom's best friend of 20-years is married to a federal judge, she's not joking.
Posted by rivka (Member # 4859) on :
quote:Originally posted by Shanna: As I was strapped to a gurney with an oxygen mask over my face and struggling to stay conscious, I guess I missed the small print.
Silly you.
Glad your mom was able to help, but it sucks that that's what it took.
Posted by Samprimary (Member # 8561) on :
quote:So after many threats and somehow managing to get into a three-way call with the hospital and the insurance company at the same time, we got the real reason for the bill. Basically, my hospital in IN-NETWORK but my ER doctor was not. The hospital "kindly" informed us that the ER has a sign posted explaining that the current doctor on call may not accept insurance. As I was strapped to a gurney with an oxygen mask over my face and struggling to stay conscious, I guess I missed the small print. I was able to provide my insurance card during a moment of consciousness and yet nothing was said to me at the time or to my parents who showed up twenty minutes later.
Originally, the hospital billed the insurance company with everything listed as in-network. Insurance paid them, I paid them, all was well. Eight months later, the doctor finally realizes that he doesn't accept insurance and therefore should have been paid at a rate five times higher than what he received. He (and the reps for his group of fellow non-insurance-accepting jerks) came after my insurance company for the extra dough. Insurance company demanded a refund, refiled the claim, and then I was billed for my new remainder.
well at least it's not socialism, right
Posted by Rappin' Ronnie Reagan (Member # 5626) on :
quote:Originally posted by Shanna: So after many threats and somehow managing to get into a three-way call with the hospital and the insurance company at the same time, we got the real reason for the bill. Basically, my hospital in IN-NETWORK but my ER doctor was not. The hospital "kindly" informed us that the ER has a sign posted explaining that the current doctor on call may not accept insurance. As I was strapped to a gurney with an oxygen mask over my face and struggling to stay conscious, I guess I missed the small print. I was able to provide my insurance card during a moment of consciousness and yet nothing was said to me at the time or to my parents who showed up twenty minutes later.
That is absolutely ridiculous. I guess people with serious trauma are supposed to wait for the next shift or go to a different ER if the doctor on call doesn't accept their insurance?
Posted by Belle (Member # 2314) on :
I have never heard of such an idiotic policy. no hospital should hire an emergency doctor that does not take all the insurance that the hospital does. It should be a condition of employment.
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good to see ya!