So frustrated-stuckin limbo b/t insurance co & hospital re: medical bills-any advice?

[jenfromnj]

I am having an issue with several medical bills relating to DS's birth in March, the rhogam shots I had to receive while PG, and some health issues he's had. In short, everything was appropriately pre-approved and pre-certified, and no one is denying that. However, the hospital is claiming that I am still responsible for the portion of my bill not paid by insurance, over and above any co-pays. In short, the insurance company claims that they made payments as part of a "global" monthly payment for portions of the bills (things like the actual contents of the rhogam shot), which the ins co is claiming was paid and therefore, the hospital is illegally balance billing me. Ins co has sent several letters to hospital saying this. Hospital billing dept claims that I am somehow still responsible, and that it's NOT balance billing, but somehow whenever I ask for a supervisor to get more details and discuss, they're 'in a meeting' or 'unavailable'--this has literally happened 10 times or more.

The insurance company has even spoken to the hospital billing dept per ins co reps, and I was told on 9/26 that it had been resolved--until I received a notice over the weekend that the bills had been sent to collections.

I have wasted so many hours trying to sort this out, and I am trying to figure out what course of action I can take, since calling and calling and writing letters does not seem to be making a difference. Has anyone had a similar issue (or know more about insurance companies and/or hospital billing than I do) and have any suggestions? They'd be greatly, greatly appreciated! We really aren't about to pay thousands out of pocket for covered services, but having my credit completely ruined isn't really an option, either. I know we can get a lawyer, (we're both lawyers, but don't do anything like this) but trying to keep that as a last resort. TIA!

[hanaum02]

I'm so sorry - how frustrating!! I don't have any insight to help, but my husband works in healthcare and is generally pretty good at this stuff. Let me check with him and get back to you.

Michelle

[Octobermommy]

Maybe I can help. Is your insurance company contracted with the hospital? That is usually the answer. If they are contracted then they have agreed to take a certain dollar amount for a delivery and they can't bill you the difference. If they are not contracted then they can bill you the difference.

HTH! Insurance is frustrating

[crl]

I had some luck with the ombudsman's office at a hospital once over billing issues. In the end, our insurance covered it, but the person at the ombudsman's office was very polite, helpful, returned phone calls, etc. Much better than the billing office. You might see if your hospital has such an office and try them.

Catherine

[Cheburashka]

I'm not entirely sure how the hospital hierarchy works, but there's probably someone above the billing dept you can try calling or emailing about this.


I know we can get a lawyer, (we're both lawyers, but don't do anything like this) but trying to keep that as a last resort.

Do you know anyone, either a friend or friend of a friend that could look over everything for you? Just as a preliminary thing?

I'd be very frustrated too. :grouphug:

[annasmom]

I am so, so, so sorry.

I had an absolutely horrendous experience with insurance after my dd1's birth. It wasn't completely settled until well after my second child's birth. It was really stressful, because I was receiving bills for hundreds of thousands of dollars associated with her birth and hospital stay.

What really worked for us was getting the HR person in charge of benefits at my dh's job involved. The woman worked wonders. I will forever be in her debt.

[codex57]

I'd also go to car-seat.org and in the Community Forum, post this question. Or PM a user named Splash (who I believe works in a hospital's billing dept.)

[writermama]

From your description, it does sound like balance billing ... and it is suspicious that no one is ever around to talk to you. If you're not ready to get a lawyer, a call to the insurance commission for your state might help you better know your options.

Good luck.

[bubbaray]

I had the exact same thing happen to us when we were on a trip to Palm Springs a few years back. DD#1 had to go to the ER (to one of the top 100 hospitals in the US -- and it was disgustingly filthy, with blood everywhere within her reach, sooooo gross). We had travel medical insurance and they paid the hospital in a timely manner, but I kept getting bills from the hospital for nearly a year afterwards.

I am also a lawyer and I had to get REALLY nasty and file a written complaint to the hospital about their collections practices. While I was at it (and mainly b/c they pi$$ed me off, otherwise I wouldn't have bothered), I filed written complaints about the two nurses who were pretty much abusive to DD#1 AND about their filthy and unsanitary conditions. When I did that, that definitely got the hospital's attention.

[trales]

I was going to suggest your HR person from work and the ombudsman at the hospital. Make an appt to go in person and go over the bill with them. Get stuff in writing with the name of the person at the insurance co. who has spoken with the hospital and the name of the person and dates they spoke.

[jenfromnj]

Thank you all for the great suggestions so far!

To answer some of your questions:

Yes, the insurance co does have a contract with the hospital, but they are claiming this as an "exception" and therefore not applicable to balance billing rules etc, for reasons they don't seem to want to explain. Definitely shady behavior, which somewhat surprises me since they are a large, very well-respected hospital in the NYC area.

We have tried to enlist the help of HR to address this, but they have been totally unhelpful (layoffs have made them extremely short-staffed so I don't entirely blame them). I am trying to escalate it to the Director of Administration, who is technically responsible for HR.

I will definitely try reaching out to the ombudsman and the hospital administration (just remembered one of the partners at my old firm is on the Board of Directors of the hospital, so may need to make a call there), as well as the state's insurance commission--thanks for those suggestions!

Bubbaray--I can't believe that happened to you at such a hospital, too! We had a similar bad experience with my husband's care at a major, top-rated hospital in NYC that was supposed to be the best for dealing with conditions similar to my husband's (he has an autoimmune disorder). Many people around here (in north NJ) are "hospital snobs" and go into the city to have major surgeries, cancer treatment, etc, assuming they'll get better care, but one of those elite hospitals almost killed my husband because of their arrogant and obstinate ER docs and nurse, and were so rude they made me cry (and I am NOT a cryer by any means!). It was several years ago, and I am kicking myself for not creating more of a stir at the time.

[tiapam]

I know there are people who actually deal with your medical bills for you for a fee. Possibly cheaper and easier than using a lawyer right away, and I imagine they would know quite a bit about this sort of thing. I can't remember what they call themselves, but I have seen some articles in news magazines and newspapers. Maybe they have an association?

[codex57]

medical coders.