Medical bill advice...can I fight this?

[TaChapm]

I am so irritated and need to know if there is any way I can fight this. We received a bill yesterday from Tyler's birth. It is saying we owe $857 (this is after insurance) for his medical expenses when he was delivered. It bothers me that is is almost a year later and we are just now seeing this.

Here is what really has me fired up. When Tyler was born he was taken into the NICU around 9pm and was released to me at 12:10 am. He spent a total of 3 hours and 10 minutes in there under observation for breathing difficulties. Nothing major at all! The hospital is charging me for 2 FULL days in the NICU since he checked in on June 9th and was released 10 minutes into 10th. This is what the vast majority of the charges are for. I had been told several times that they would be bringing him into me in 30 min etc. and DH said it was just like they were trying to keep him in there to get the extra day billing. Not to mention the fact that the gave him the wrong type of formula while in there (soy not regular like I had requested) and didn't bother telling me. I discovered it in a picture that Jacob had taken of his first bottle since I wasn't there.

I am really irritated by the entire situation and am wondering if there is any way to fight the charge for the second day. There is no nursery at the hospital so the baby has to room in with you (which I like) so the charge isn't a regular nursery charge it is for the NICU.
We are so incredibly broke right now and seem to be drowning in medical bills and this was just the icing on the cake.

I have no problem paying for anything that was done to him like the chest x-rays, labs, etc. but the NICU room fee is KILLING me. It just doesn't seem right.

Tara
Mommy to Jackson 11-10-02
Tyler William 6-9-05
OMG!!! It's a GIRL!! Due September 5, 2006!

http://b4.lilypie.com/gzWfm8.png

http://b1.lilypie.com/kLMem8.png

http://bd.lilypie.com/UEZ3m8.png

[JBaxter]

Yes call and ask to speak to someone about a dispute on a bill. They should connect you with someone. According to my mom ( a RN) there are people in the hospital who takes care of things like that. Just explain 1 day you understand but 2? They adjust those things alot at where my mom works. Explain your talking about 10 min.

[trumansmom]

All medical bills are negotiable. I would call the hospital, ask why you hadn't received this before now. And then point out that he was NOT there for two full days, but for a brief time that happened to include midnight. If you are calm and reasonable in your approach, odds are they will make the adjustment.

Good luck!

Jeanne
Mom to Truman 11/01 and Eleanor 4/04

[DebbieJ]

Absolutely call the hospital billing dept and dispute it. As a PP said, if you are kind and reasonable, I'm sure they will do something.

~ deb
DS born at home 12/03
2 year check up: 25 lbs with clothes on and 35 inches!
BFARed for 20 months and 6 days
(Breastfeeding After Reduction is possible! www.bfar.org)

http://www.bfar.org/members/fora/style_avatars/Ribbons/18months-bfar.jpg

[nathansmom]

Honestly you may be able to fight it but I wouldn't count on it. Remember my problems with the nicu bills with Noah? We ended up settling for just under $9000. Your hospital can help for some of the fight but if its billed through Peditrixx/Obsteritcs your screwed. They will not adjust or cut you a break no matter what. We fought them for almost a year before they turned it over to collections without once cutting us a break. I despise that billing company and in the future will ask at the hospital/doctors office who does their billing. I will never allow a child of mine to enter a nicu who uses that company for billing.

[kijip]

IME hospitals can work with you on the bill. Even if they won't adjust the amount (which they may) they often can write some of it off if you are having financial problems.

[megs4413]

Check also with your insurance provider and see if they have a patient advocate. They can help you navigate through the process. The hospital may also have a patient advocate on staff. You can also speak to the hospital social worker and have that person help be a representative for you. If you do not get anywhere with them I would ask for an itemized bill. You need to know EXACTLY what you're being charged for. Then, go through the insurance explanation of benefits that you have for the same hospital stay (i'm assuming since you said it was after insurance that they paid something for this visit). If you see the same things being billed on both your statement and the one that the insurance made its adjustments with (let me know if I need to clarify this) you can request that they adjust the service to the insurance price.

I'm sure you've noticed that if your insurance settles a bill with them for let's say..lab work...the E.O.B. will show how much the insurance company "allows" for that service and the adjustment to the price and payment. Most billing offices if they know you have documentation that that is how much the service costs, will give you the adjustment even though you're not an insurance company. If they don't you have more ammunition to go at them in an appeal or whatever that particular hospital's process is for disputing bills.

Let me know if you want me to be any more clear. During my pg, i had hypermesis and was hospitalized and had home health for a long time. Right after my last home health appoinment my husband began chemotherapy. He had been diagnosed with cancer about a month before I was well enough to get my central line out. We are no strangers to the nightmare that is the american health care system. We had insurance and still manage to find ourselves in collections for things we've never heard of that happened 2 years ago. You can PM me if you need any more help or if you need help for other situations. I'm sorry you're dealing with this. It's just the worst!

Those medical billing @@^&#^#&(#)@*&!&*s!

[deenass]

Regardless of how much you end up owing, do not feel like you have to pay it all at once. When the final amount is resolved, call the billing office and tell them you would like to pay on a payment plan. I have bills from 2002 that I am STILL paying off (at $10 a month with no interest). I simply said that was all I could afford to pay.

[TaChapm]

I just spent over 2 hours on the phone between the hospital, insurance and the hospital again. The hospital won't budge on the bill according to the billing department. I asked to speak with someone else and was told that it will not change. I don't know where to go with this.

According to my insurance the bill is incorrect. They pay for mom and baby together. It should have been covered 100% and according to them was paid at that. The only way the insurance will pay seperate on baby is if he is sick so NICU is seperate but is not being billed or paid that way. The insurance says it has paid for all lab, x-rays, pharmacy and the circumcision in my bill which leaves the NICU fee to be paid. The hospital says none of Tyler's bill has been paid. I am having them pull my bill which has been archived to see if it was overpaid.

Here is the funny thing. I remember asking the day after Tyler was born if they could take him to the nursery for 2 hours since he was up all night with breathing difficulties and in return we were up all night. Since he was still having the problems that afternoon I still was not comfortable taking a nap without someone watching him. They would not take him. They said that babies are room in only and we can't request that they be taken out so we can sleep. The nurse actually told me I needed to get used to no sleep. (No Kidding) It would have been a little different if he wasn't struggeling to take every breath and grunting. So we actually had to pay for that extra day (10 min) in the NICU but they wouldn't take him back in when I was concerned and wanted someone to watch him.

UGH...I love my OB but she only delivers at this hospital and the thought of dealing with them again is getting me all worked up.

Tara
Mommy to Jackson 11-10-02
Tyler William 6-9-05
OMG!!! It's a GIRL!! Due September 5, 2006!

http://b4.lilypie.com/gzWfm8.png

http://b1.lilypie.com/kLMem8.png

http://bd.lilypie.com/UEZ3m8.png

[bcky2]

ugh tara, i was going to ask if there was another hospital to deliver your little girl at. i hate, hate, hate ins and hospital bill issues. i had to fight with my dh's ins one time because they had max my older ds as the policy holder when he was only a few days old!!!!!!!!!! needless to say they didnt want to pay for him to go to well baby visits. i really hope that you get it resolved and that you dont have to go thru this again.

[o_mom]

I would work on the incorrect billing from the hospital. The ten minutes being charged for a whole day is pretty standard (We had a baby at 11:30 pm, so I know all about the "partial day" bit).

Depending on your insurer, the hospital may have to accept the amount paid under contract. I know we get EOBs all the time that say "patient is not responsible for difference". Tell the hospital that according to your EOB, you are paid in full. If they want more money they will have to re-submit the bill to the insurance with the correct codes. Don't let them tell you that it is your problem! They are the only ones who can change the billing codes.

Also, they may be reluctant to bill the insurance since it has been so long. Usually they have to submit within a certain time frame (90 days) or it can be denied. With DS1, the hospital ped waited 6 months to send me a bill, then submitted to ins. Insurance co. denied it and said that we were not responsible, either since the ped didn't play by the rules.

[jamsmu]

Tara, this completely sucks. I wish I had advice, but I totally understand you being po'd. Its really good that you called right away to open a complaint. Did you're insurance company give you any advice, ie who to talk to? Also, I wouldn't back down with the hospital telling you that no one will do anything for you. If you ask to speak to a manager, then its their responsibility to give you a manager to speak with. I'd keep calling up the food chain until its resolved.

Sorry to hear its the only hospital for your OB... hmmmm... maybe your OB's insurance contact can help you on this one?

[megs4413]

on that note......it's called timely filing. The insurance company requires that the billing agent submit the claim in a "timely" manner. The way to get them to resubmit is to have them resubmit with the original denial. They need to include an itemized bill, the original claim form, the original E.O.B. with denial explanation, and then a new claim form. If they show that they did file it on time originally and were mistakenly denied benefits, the insurance company will still make a payment. It sounds to me like you need to get someone from the insurance company to help you. Try to talk to a patient advocate or a supervisor in the claims department.


If you can't get the hospital to resubmit you can request the necessary documents and resubmit yourself.

on another note you should probably report this hospital for unfair billing practices. Medical centers have agencies they have to report to so they can keep their licenses and certifications. I don't know where you live but if you go to your local government's website, it should have a link for licensing agencies or something like that. Then it should have a section where you can report a problem.

Good luck with all of this! I'm going to PM you.

[aa2mama]

Medical billing issues suck. We received a big bill from the hospital several months after DS's birth that should have been covered by insurance. I would call the hospital, and they would tell me it was the insurance company's fault. I would then call up the insurance company, and they would tell me it was the hospital's fault. This went on and on. Finally, I showed up at the insurance company and asked to talk to a representative. I told them that I wanted to get to the bottom of it right then and there. I waited while they made some phone calls and within a relatively short amount of time the whole mess was straightened out.

If I had continued making phone calls back and forth, I would probably still be dealing with it to this day.

[Toba]

Can I ask what state you're in? My husband is a director at two NJ hospitals and says in this state, you can NOT have an L&D with no nursery (seperate from their NICU).

Regardless, he said go to the state health department. Tell them that you continually asked for your child to be returned to you (after being told it would only be 30 minutes) and they refused/delayed until 10 minutes into the next billing day. And THEN tell them that your child who was having breathing difficuties was being refused attention in the NICU that you were billed for.

He also said to call the COO (chief operating officer) of the hospital, as he is the "end all, be all" of patient complaints. Just call up the switchboard operator and ask to speak to the COO. :)

~Kimberly Anne~
Noah Nevan, March 12, 2004
*the light of my life*

[o_mom]

Also forgot to mention.... if you think the insurance co is in any way at fault or screwing this up, do not hesitate to call your HR rep. (assuming the ins. is through someone's work). The company pays ALOT of money to the insurance company to buy the insurance or administration. They are not happy when they don't get what they paid for. I have found that a call to HR will usually light a fire under the insurance co....

[TaChapm]

We are in Texas. The hospital actually has a nursery aside from the NICU but it has never been open (at least when we were there) and is not staffed. Depending on what my account says tomorrow I will probably try to contact the COO if it is not resolved.

Tara
Mommy to Jackson 11-10-02
Tyler William 6-9-05
OMG!!! It's a GIRL!! Due September 5, 2006!

http://b4.lilypie.com/gzWfm8.png

http://b1.lilypie.com/kLMem8.png

http://bd.lilypie.com/UEZ3m8.png

[megs4413]

are you still planning to deliver there again?

[TaChapm]

It is the only Hospital that my OB practices at and I LOVE my OB so I am stuck. With our first son we were really happy with the hospital and the entire experience. I actually want my babies with me instead of the nursery but Tyler's case was a special situation that I was not comfortable with. I hate that now I will be going there with my guard up.

Tara
Mommy to Jackson 11-10-02
Tyler William 6-9-05
OMG!!! It's a GIRL!! Due September 5, 2006!

http://b4.lilypie.com/gzWfm8.png

http://b1.lilypie.com/kLMem8.png

http://bd.lilypie.com/UEZ3m8.png

[Toba]

I would look into the nursery issue further. The reason my husband knows about this law is because THEY have three nurseries (two nurseries and one NICU, actually) and both of the regular nurseries were unstaffed when the state came in and did an inspection ... they were cited because of it several years ago.

I can't speak from experience because I'm not in the medical field and my husband is in bed so I can't ask him (LOL), but it seems truly OFF to me that they wouldn't have an operating nursery. What if the mother had a complication or something, but there was nothing wrong with the baby ... what do they do with the newborn in that situation? Leave him in the room with the incapacitated mother? My husband said it is law here that a healthy baby can't be in the NICU with NICU babies (what his hospital was doing when they were cited) ....

Just something to think about ... and maybe a little thing you can ... ahem, mention to the COO if it gets that far (if you indeed can find out about that regulation/law in your state).


~Kimberly Anne~
Noah Nevan, March 12, 2004
*the light of my life*

[egfmba]

Wolfsong, if you can find out the name of the law (or title or anything like that), the OP can look up a similar statute here in Texas.

OP, go to http://www.capitol.state.tx.us/statutes/statutes.html. It's the Texas Statutes website. The site has all the Texas statutes listed by subject. The Health & Safety code has info on hospitals, and you can even search just that part of the statutes to find out if we have a similar statute. Just click on the "Search" tab at the top.

I also second the call to the COO. Or, at least try to get a hold of the hospital attorney. When attorneys hear "possible liability" they can make things really start happening.

Good luck, and don't forget to call your local HMO rep. That may be at HR or, if your spouse is with the city, there may be a rep for the whole city or just your department. They can also make things happen, especially if they're looking at your contract and records, to which they have complete access.

Hope this helps in some small way.

eva