Stupid Humana! Stupid Hospital!

[mommd]

Ugh, I HATE Humana and the hospital I gave birth in!! DD's birth still has not been paid for, and she's almost 8 months old! Humana was supposed to cover 95% of the cost, but they keep subtracting a "provider adjustment" saying that we don't have to pay, but the hospital keeps billing us. Of course, it's a big secret as to what this adjustment is. Than, the hospital charged me for a doctor who was in the room for 5 minutes and didn't do ANYTHING (he came first because DD was coming fast and the midwife wasn't sure she would make it). No way I'm paying for that! I hate the health care industry!

[Marisa6826]

I know with Aetna, the doctors and hospitals legally can't bill you for more than your copay once they've been paid by the insurance company - assuming you went 'in network'. They have signed a legal contract between the two of them and a deal is a deal.

I would definitely get to the bottom of the doctor that didn't do anything, as well.

Call your State's Insurance Commissioner if it continues.

Good luck

-m

[jubilee]

I've worked in medical insurance claims and now I do medical/surgical billing- so if there is anyway I can help, let me know. Have you recieved your EOB (explaination of benefits)? If you don't know what an EOB is, it is an itemization of the charges broken down by date of service and provider. The insurance can send you it, some insurances routinely send them out monthly and some never send them unless you request it. In all you should also get a statement/bill from each provider- hospital, midwife, consulting OB, etc. Compare the statement/bill against the EOB to be sure all "write offs" have been adjusted by the provider. Also, you may have a deductable that must be met before the 95% coverage kicks in... and some services may not be covered at 95% (for example, durable medical goods - this would be like a splint, brace, etc. Those are typically paid at 80%, but again depends on your plan. Probably doesn't apply to you.)

Anyway, let me know if I can help! Medical billing is often confusing, even for those of us in the field!

[KYBelle1102]

I agree with the PP...I'm an HR Manager, so I have to deal with insurance all the time. If it's an in-network hosptital, they should write off the "adjustments" for network discounts. If by chance the hospital you went to is not in-network, then that adjustment that Humana made was to adjust the price down to what they call "Usual, Customary & Reasonable". An out-of-network hospital CAN bill you for that (called balance billing). Also, sometimes claims get processed funny just based on how they hit the claims center. I had an anesthesia bill get processed out-of-network simply because it hit claims before my hospital bill. Anesthesiologists are never networked because you don't have a choice in your anesthesiologists.

First thing I would check: Was the hospital In-netowrk or Out? If it was in-network, I'd find out how much was billed, how much was to be written off for discounts, how much applied to deductible, then how much was paid on the remaining.

HTH

[sadie427]

No fan of Humana myself. I went to the pharmacy to refill my birth control expecting to pay my usual $10 copay and the pharmacist said it had gone up to $30! When I went home I called them, hoping it was some kind of mistake, and they said "gee, you should have gotten a letter . .!" Turns out they are raising the copay of ALL forms of birthcontrol to $30 a month! Just because they can get it, not because the cost has gone up, I have looked up the retail price of my prescription and it is $38, so they are really barely saving me anything.

However, because I complained on the phone, they told me they'd grandfather in the $10 copay thru the end of the year, which saves me $100. So it is worth calling to complain, although perhaps you've already done that.

[tippy]

Arg...I feel your pain! I gave birth to ds in Jan of 2003 and was still dealing with billing nightmares in Nov. I gave birth in NYC at StLukesRoosevelt. I was told that the "hospital" accepted my insurance which was Bl CrossBl Shield at the time. I was also told my Perintology group was covered under BCBS as well. Turns out the Dr. who actually delivered ds was new to the group and hadn't been provided a "provider number" by the insurance company yet so they were treating him as out of network. I was also billed directly by the anesthesiologist, and pediatrician that looked at ds since they weren't participating providers. Needless to say I was on the phone with the hospital and the insurance company for what seemed like HOURS every day for months and months. All this while trying to take care of a newborn! I ended up fighting with the insurance company who in the long run billed everything as in-network even though the dr's in question were out of network. They said they would do this since I was told upfront that my insurance was accepted. Good luck. I know how frustrating this can be but be persistant and don't give up. Hopefully it will work out in the long run.

[mommd]

Well, here's the problem. DH's company is based in Schaumburg
(suburb of Chicago), but they have a branch in Central Illinois, where we are. So "in network" is in Chicago. Since we live out of network to begin with, they are supposed to treat our hospital as in network and pay for it that way. This was never a problem with the previous insurance, only since Humana took over in January.

So what you're saying is that the hospital should write off the adjustments and not charge for them. But since we are out of network, the hospital doesn't have a contract with Humana, so we have to pay the difference? What a mess...

[PJAlama]

If we had a national health plan like every other industrialized country in the world, we wouldn't have to waste precious time wrestling with insurance companies when we have kids to care for.