PDA

View Full Version : Medical Bill help


1Mouse2RulethemAll
01-29-2012, 08:17 AM
I received a lovely little budget buster in the mail Friday...a medical bill from more than 4 years ago. The hospital want's more than $1500, yet I was covered under Medicaid at the time.

What do all you budget smart people suggest I should do?

deegack
01-29-2012, 08:33 AM
call medicaid and the hospital and find out whats up. I know when I had my daughter the hospital had 22 months to bill me for anything.
Worst case, you have to pay but at this point I would only send it what you can easily afford.

lost*in*cyberspace
01-29-2012, 10:36 AM
What do all you budget smart people suggest I should do?

It depends. Look at the bill carefully. Is it really from the hospital or is it from a debt collection agency (most likely)?

1Mouse2RulethemAll
01-29-2012, 12:01 PM
It depends. Look at the bill carefully. Is it really from the hospital or is it from a debt collection agency (most likely)?

It's from the hospital. Medicaid should have paid it all at the time and they did pay some. It looks like the hospital is trying to get the balance from me that the insurance did not pay. I thought that was illegal.

mistysue
01-29-2012, 12:20 PM
If medicaid didn't pay the whole thing (part of it probably wasn't eligable?) then you owe the balance.
That isn't illegal, it's how insurance works and medicaid is like an insurance.

It is strange that they waited 4 years though. I would call and ask what it is because they should NOT be waiting that long to bill you. Unfortunately, there are rules on how long they can take to bill insurance, and it is written right into policies and the doctor's forms that you sign that if they bill late, you are still liable for it. Once I had a pediatrician "forget" to bill for my daughter's visit until after 90 days. Well, insurance only has to accept it up to 90 days after the date of service, so now I was liable for the entire visit. I had paid my copay on the date I was there. Technically, they were legally allowed to come after me for the balance. I acted like I didn't know that, kept complaining and they dropped it.

Pinnie
01-29-2012, 02:00 PM
I received a lovely little budget buster in the mail Friday...a medical bill from more than 4 years ago. The hospital want's more than $1500, yet I was covered under Medicaid at the time.

What do all you budget smart people suggest I should do?

Looking at your signatures suggests you have the money to pay the bill. Maybe you better rethink the Hawaii trip. Just sayin.....

Lintasare
01-29-2012, 02:03 PM
If medicaid didn't pay the whole thing (part of it probably wasn't eligable?) then you owe the balance.
That isn't illegal, it's how insurance works and medicaid is like an insurance.

It is strange that they waited 4 years though. I would call and ask what it is because they should NOT be waiting that long to bill you. Unfortunately, there are rules on how long they can take to bill insurance, and it is written right into policies and the doctor's forms that you sign that if they bill late, you are still liable for it. Once I had a pediatrician "forget" to bill for my daughter's visit until after 90 days. Well, insurance only has to accept it up to 90 days after the date of service, so now I was liable for the entire visit. I had paid my copay on the date I was there. Technically, they were legally allowed to come after me for the balance. I acted like I didn't know that, kept complaining and they dropped it.

Medicare and Medicaid have different timely filing limits than regular insurance. I work for a BC/BS plan and we are getting Medicaid claims from 5 years ago and we have to take them and process them.

momto2inKC
01-29-2012, 02:07 PM
It's from the hospital. Medicaid should have paid it all at the time and they did pay some. It looks like the hospital is trying to get the balance from me that the insurance did not pay. I thought that was illegal.

Just like with any insurance, if there is a balance after the insurance has paid, you are responsible.

Lintasare
01-29-2012, 02:24 PM
Just like with any insurance, if there is a balance after the insurance has paid, you are responsible.

And I have never known Medicaid to pay 100%.

mrsklamc
01-29-2012, 02:30 PM
It's from the hospital. Medicaid should have paid it all at the time and they did pay some. It looks like the hospital is trying to get the balance from me that the insurance did not pay. I thought that was illegal.

Insurance? If you had insurance, it should be billed first, THEN medicaid, then you.

mrsklamc
01-29-2012, 02:37 PM
In fact if you had insurance in addition to the Medicaid, that may be the reason for the delay. Sometimes when there are two payors it takes awhile for them to argue out who pays for what.

maxiesmom
01-29-2012, 02:41 PM
:confused3I suggest you pay the bill asap as you are responsible for it.

I guess I don't understand what kind of advice you are looking for, other than that.

marmalade
01-29-2012, 02:47 PM
Looking at your signatures suggests you have the money to pay the bill. Maybe you better rethink the Hawaii trip. Just sayin.....

The OP never said anything about not being able to pay the bill. It's from FOUR years ago and this is the first she's heard of it. I would NEVER pay a $1500 bill that just showed up in my mailbox from 4 years ago without investigating it first.

mdsoccermom
01-29-2012, 02:48 PM
My suggestion is pay and be done with it. In fact, I can't think of any other reasonable solution. Take the money you were going to use for Aulani. You may have to postpone the trip, but that's life.

mdsoccermom
01-29-2012, 02:50 PM
The OP never said anything about not being able to pay the bill. It's from FOUR years ago and this is the first she's heard of it. I would NEVER pay a $1500 bill that just showed up in my mailbox from 4 years ago without investigating it first.

Well, the fact that she asked "budget smart" people on a budget board what to do suggests she is looking for a financial solution.

dcfromva
01-29-2012, 02:54 PM
I received a lovely little budget buster in the mail Friday...a medical bill from more than 4 years ago. The hospital want's more than $1500, yet I was covered under Medicaid at the time.

What do all you budget smart people suggest I should do?
I don't know if this would fall under the category of balance billing which in many states is illegal or if you received care for an uncovered expense (or a non-participating provider--though if the medicaid paid something on this they probably are a participating provider. :confused3 )

Well, anyway, I googled Oklahoma Medicaid and found a link to
http://www.okhca.org/publications/pdflib/SC_handbook.pdfSoonerCare Choice 2011 Member Handbook (http://www.okhca.org/publications/pdflib/SC_handbook.pdf)

This is the advice given from the Handbook:

"Usually, you will not get a bill from a SoonerCare provider. Sometimes, you will get a “statement” from a provider that is not a bill. If you are not sure, call the provider and ask if you have been billed. You may have to pay the charges.
You may have to pay if:
► You got services that were not covered.
► You got covered services from an out-of-state provider not contracted with SoonerCare.
► You got services without the needed referral from your PCP-Medical Home.
► You got services from a provider who does not accept SoonerCare.
You also may be billed for co-payments if you are unable to pay them at the time you received the service.
If you get a bill and do not think that you have to pay for the charges, call OHCA at
1-405-522-7171 or 1-800-522-0310. Give the following information:
► The date of the service.
► The amount being charged.
► Who is billing you.
► Why you are being billed.
It is a good idea to have the bill with you when you call. We will help you understand what was billed to you and whether you may have to pay it."


edited to add this note was also in the handbook:
"SoonerCare cannot repay you for services you have paid for."

marmalade
01-29-2012, 02:55 PM
Well, the fact that she asked "budget smart" people on a budget board what to do suggests she is looking for a financial solution.

And any budget smart person would not pay a bill for $1500 from 4 years ago without looking into it first.

a1tinkfans
01-29-2012, 02:55 PM
IF you had other insurance at the time of service, often times co-insurance claims get delayed for a myriad of reasons...But, they/hosp may have waived their right if THEY delayed the billing KNOWING that you had other insurance. That being said, IF they did NOT know you had other insurance because you forgot/etc to notify them, then you will be stuck paying because the "other" carrier will deny due to delay..
I would call if it is the hospital (NOT if its a debt company), ask them for proof they billed, what they got paid and by whom and any all denials. Follow that with a written letter indicating what they TOLD you and that you are awaiting the proof for this long delayed billing.
Then await proof, review to see if in order...perhaps the other company is actually at fault for not paying...you need to review it all and figure out what went wrong, if it did. Then
either process it accordingly and by that I mean, pay it if you can outright...OR ask them for a billing plan if you can not.
Good Luck....perhaps you will learn that something went awry and itll get resolved with minimal payout from you/co pay or deduct??:confused3

:wizard:

mdsoccermom
01-29-2012, 03:05 PM
And any budget smart person would not pay a bill for $1500 from 4 years ago without looking into it first.

That's just common sense. A person should know to do that without asking random strangers on a message board.

Halle
01-29-2012, 03:07 PM
If medicaid didn't pay the whole thing (part of it probably wasn't eligable?) then you owe the balance.
That isn't illegal, it's how insurance works and medicaid is like an insurance.

It is strange that they waited 4 years though. I would call and ask what it is because they should NOT be waiting that long to bill you. Unfortunately, there are rules on how long they can take to bill insurance, and it is written right into policies and the doctor's forms that you sign that if they bill late, you are still liable for it. Once I had a pediatrician "forget" to bill for my daughter's visit until after 90 days. Well, insurance only has to accept it up to 90 days after the date of service, so now I was liable for the entire visit. I had paid my copay on the date I was there. Technically, they were legally allowed to come after me for the balance. I acted like I didn't know that, kept complaining and they dropped it.

Physicians sign agreements with insurance companies, they are responsible for filing a claim within the time limit. If the claim isn't filed it is not the fault of the patient. Did you check with your insurance company?

momto2inKC
01-29-2012, 03:10 PM
That's just common sense. A person should know to do that without asking random strangers on a message board.

I agree...I didn't take it as the OP was asking for advice on what she should do next. It's pretty much common sense that you make sure you owe something before paying it. I took it as the OP was seeking advice on paying the bill, fitting it into her budget since she said she came here to ask the 'budget smart' people how they would handle the unexpected budget buster.

snowwite
01-29-2012, 03:11 PM
If you had Insurance and Medicaid then the Insurance should have paid as the Primary (first) payor as Medicaid is always the last payor. If you only had Medicaid then the following applies and the provider can be fined for breaking the law.

This is from CMS:
While providers and facilities may choose whether to participate in the Medicaid program, those who do must comply with all applicable guidelines, including “balance billing.” It’s also important for providers to understand that Medicaid is considered to be the payer of last resource, meaning that if the patient has other coverages, they should be billed prior to billing Medicaid.

It goes against the Medicaid guidelines to balance bill a Medicaid patient, their family or their power of attorney for any unpaid balance once Medicaid has paid what they allow under the Medicaid fee schedule. This simply means that the provider must adjust off the leftover balance once any applicable charges for a copayment, deductible or coinsurance is met.

NOTE: A balance does not constitute, “coinsurance” due.

42 C.F.R. § 447.15 Acceptance of State payment as payment in full

A state plan must provide that the Medicaid agency must limit participation in the Medicaid program to providers who accept, as payment in full, the amounts paid by the agency plus any deductible, coinsurance or copayment required by the plan to be paid by the individual.

Basically, this means that a provider is not to bill the difference between the amount paid by the state Medicaid plan and the provider’s customary charge to the patient, the patient’s family or a power of attorney for the patient.

Find your proof of coverage for the time of the service, request a copy of your medical record as well as a detailed bill (ask for the UB and detail) so you can see if you signed anything agreeing to be balance billed.
Since the bill is very late I would be very suspicious about it being from a bill collector or being sent in error after the hospital did an audit.
I work for insurance and there are a lot of unscrupulous providers who will try to make a profit any way they can.
I would make them prove that you actually owe it before you pay them a dime. If you actually owe it then negotiate it down to a fair amount. Most providers inflate costs by at least 200% and as much as 600%. When we reduce to R & C (reasonable and customary it is 200% of the Medicare allowable. I would tell them you refuse to pay more than R & C.
Most likely they will drop it.

angierae
01-29-2012, 03:13 PM
The OP never said anything about not being able to pay the bill. It's from FOUR years ago and this is the first she's heard of it. I would NEVER pay a $1500 bill that just showed up in my mailbox from 4 years ago without investigating it first.

This. Do you have any statements or receipts from what was paid, so you can compare what they are billing you with from what was paid before? I would NEVER EVER just pay a bill that was that old. My dentist office kept trying to get me to pay $1000 that come to find out they'd never billed my insurance company for. I called, they dealt with it, the insurance company paid it. Why on EARTH would you pay something without investigating whether or not you actually owed the money?

marmalade
01-29-2012, 03:15 PM
IF you had other insurance at the time of service, often times co-insurance claims get delayed for a myriad of reasons...But, they/hosp may have waived their right if THEY delayed the billing KNOWING that you had other insurance. That being said, IF they did NOT know you had other insurance because you forgot/etc to notify them, then you will be stuck paying because the "other" carrier will deny due to delay..
I would call if it is the hospital (NOT if its a debt company), ask them for proof they billed, what they got paid and by whom and any all denials. Follow that with a written letter indicating what they TOLD you and that you are awaiting the proof for this long delayed billing.
Then await proof, review to see if in order...perhaps the other company is actually at fault for not paying...you need to review it all and figure out what went wrong, if it did. Then
either process it accordingly and by that I mean, pay it if you can outright...OR ask them for a billing plan if you can not.
Good Luck....perhaps you will learn that something went awry and itll get resolved with minimal payout from you/co pay or deduct??:confused3

:wizard:

If you had Insurance and Medicaid then the Insurance should have paid as the Primary (first) payor as Medicaid is always the last payor. If you only had Medicaid then the following applies and the provider can be fined for breaking the law.

This is from CMS:
While providers and facilities may choose whether to participate in the Medicaid program, those who do must comply with all applicable guidelines, including “balance billing.” It’s also important for providers to understand that Medicaid is considered to be the payer of last resource, meaning that if the patient has other coverages, they should be billed prior to billing Medicaid.

It goes against the Medicaid guidelines to balance bill a Medicaid patient, their family or their power of attorney for any unpaid balance once Medicaid has paid what they allow under the Medicaid fee schedule. This simply means that the provider must adjust off the leftover balance once any applicable charges for a copayment, deductible or coinsurance is met.

NOTE: A balance does not constitute, “coinsurance” due.

42 C.F.R. § 447.15 Acceptance of State payment as payment in full

A state plan must provide that the Medicaid agency must limit participation in the Medicaid program to providers who accept, as payment in full, the amounts paid by the agency plus any deductible, coinsurance or copayment required by the plan to be paid by the individual.

Basically, this means that a provider is not to bill the difference between the amount paid by the state Medicaid plan and the provider’s customary charge to the patient, the patient’s family or a power of attorney for the patient.

Find your proof of coverage for the time of the service, request a copy of your medical record as well as a detailed bill (ask for the UB and detail) so you can see if you signed anything agreeing to be balance billed.
Since the bill is very late I would be very suspicious about it being from a bill collector or being sent in error after the hospital did an audit.
I work for insurance and there are a lot of unscrupulous providers who will try to make a profit any way they can.
I would make them prove that you actually owe it before you pay them a dime. If you actually owe it then negotiate it down to a fair amount. Most providers inflate costs by at least 200% and as much as 600%. When we reduce to R & C (reasonable and customary it is 200% of the Medicare allowable. I would tell them you refuse to pay more than R & C.
Most likely they will drop it.

I'm pretty sure this was the advice the OP was looking for.

angierae
01-29-2012, 03:15 PM
I agree...I didn't take it as the OP was asking for advice on what she should do next. It's pretty much common sense that you make sure you owe something before paying it. I took it as the OP was seeking advice on paying the bill, fitting it into her budget since she said she came here to ask the 'budget smart' people how they would handle the unexpected budget buster.

It might be "common sense" but if the OP has never had to deal with something like this, she might not know who to call first or what sort of paperwork s/he should dig out or whatnot.

If she's just worried about how to pay it, then my advice would be to call the hospital and set up monthly payment arrangements, there's no reason to pull that kind of cash out of savings all at once, the hospital will be more than happy to take a couple hundred dollars a month or whatever.

1Mouse2RulethemAll
01-29-2012, 05:50 PM
Thank you for all your responses. I really need to learn to give more information...:rolleyes:

The reason I wrote here was because I have read many times how people have dealt with medical bills, not just paying it off, but negotiating and disputing.

And yes, I can pay it off, but I do not believe I owe it and will be calling first thing tomorrow.

The charge was for my daughter's birth almost 5 years ago. I was on Medicaid only at the time and in Ohio. In Ohio, the Medicaid program is ran through HMO's and the one I was assigned to covered 100%. I had no copay and the hospital was in-network. There was no anesthesiologist, so I don't have to deal with that. Unfortunately, because it was Medicaid, I never received a bill or an EOB, so I have no paperwork. What is really fishy is the hospital received a payment the day before sending me the bill.

So, aside from calling them, I have no idea what to do next.

JustCallMeMommy
01-29-2012, 05:58 PM
I would call call the hospital first and ask for a detailed statement. Then, I would call Medicaid and see what they could tell me about the claim. I wouldn't expect an immediate answer from Medicaid - they will probably need to have someone research the claim. You state's Medicaid policy is probably on their web page.

duffy
01-29-2012, 06:05 PM
The charge was for my daughter's birth almost 5 years ago. I was on Medicaid only at the time and in Ohio.

So, this was between the trip to the Polynesian Resort on your honeymoon in 2006, and the trip to the Wilderness Lodge in 2008?

carrie1626
01-29-2012, 06:11 PM
If medicaid didn't pay the whole thing (part of it probably wasn't eligable?) then you owe the balance.
That isn't illegal, it's how insurance works and medicaid is like an insurance.

It is strange that they waited 4 years though. I would call and ask what it is because they should NOT be waiting that long to bill you. Unfortunately, there are rules on how long they can take to bill insurance, and it is written right into policies and the doctor's forms that you sign that if they bill late, you are still liable for it. Once I had a pediatrician "forget" to bill for my daughter's visit until after 90 days. Well, insurance only has to accept it up to 90 days after the date of service, so now I was liable for the entire visit. I had paid my copay on the date I was there. Technically, they were legally allowed to come after me for the balance. I acted like I didn't know that, kept complaining and they dropped it.

It's very possible this all stems from an audit and the episode wasn't billed correctly.

INFO: http://www.medicaid-rac.com/?gclid=CMjoi9669q0CFSURNAod5XUOuA

duffy
01-29-2012, 06:18 PM
People like the OP make we want to throw up. The child was born 4 years ago and you apparently qualified for medicaid which is for persons of low income and few resources, but in that time the OP managed to find the funds for all these vacations, but couldn't afford health insurance. You took state/federal funds but blew your money on Deluxe hotel accomodations.

Sometimes the DIS makes me sick.

Oh, I'm sure all those trips were gifts from loving family and friends. :rotfl:

1Mouse2RulethemAll
01-29-2012, 06:28 PM
So, this was between the trip to the Polynesian Resort on your honeymoon in 2006, and the trip to the Wilderness Lodge in 2008?

People like the OP make we want to throw up. The child was born 4 years ago and you apparently qualified for medicaid which is for persons of low income and few resources, but in that time the OP managed to find the funds for all these vacations, but couldn't afford health insurance. You took state/federal funds but blew your money on Deluxe hotel accomodations.

Sometimes the DIS makes me sick.

Our 2006 trip was a wedding present, so we did not have to pay for that. My husband lost his job in early 2007 and I was in college. As soon as he had a new job, we got off welfare, which was well before the 2008 trip. Since then, I have graduated college and he and I work very hard for our trips.

There is no shame in getting help when you need it, and we needed it at the time. Now, we are productive members of society who pay our taxes to help others in need.

Soarin Fan
01-29-2012, 07:45 PM
I live in Ohio and I have worked in the medical billing field for about 6 years. From my experience a provider can't balance bill what Medicaid doesn't cover. I would check with the hospital to make sure this wasn't a mistake the bill was sent to you, that it should have been written off instead.

stitchlovestink
01-29-2012, 07:55 PM
And any budget smart person would not pay a bill for $1500 from 4 years ago without looking into it first.
Exactly!! :thumbsup2

Physicians sign agreements with insurance companies, they are responsible for filing a claim within the time limit. If the claim isn't filed it is not the fault of the patient. Did you check with your insurance company?
As they should be...otherwise they could just sit on them and then just wait and bill the patients for the full office visit amounts since the insurance companies make them take such a "hit" on what they bill for the office visit versus what they get paid. We can't force them to file the claim in a timely manner. We are at their 'mercy' for them to file in a timely manner.

People like the OP make we want to throw up. The child was born 4 years ago and you apparently qualified for medicaid which is for persons of low income and few resources, but in that time the OP managed to find the funds for all these vacations, but couldn't afford health insurance. You took state/federal funds but blew your money on Deluxe hotel accomodations.

Sometimes the DIS makes me sick.
Are you privy to everyone's financial records and what is gifted to them?
Judge much?? :sad2:

angierae
01-29-2012, 08:01 PM
Judgmental people make ME want to throw up. The OP did not go on a trip in 2007 - clearly, because they had been hit with hard times.

There's absolutely no reason why her financial situation couldn't have changed after the birth of the child in 2007 in time for them to go on a trip in 2008.

I suppose everyone who wants to judge thinks that if they lost their health insurance while she was pregnant, they should have just gone uninsured? I don't know about other states, but in MI, if you are pregnant and do not have access to health insurance, Medicaid will cover you REGARDLESS of income (or at least this was true in 1994) because it is in the best interest of the BABY to have pre-natal care.

So why don't we all just worry about ourselves instead of judging someone's financial situation FIVE YEARS AGO.

Leajess99
01-29-2012, 08:06 PM
OP - I recently received a bill that is from medical treatment for my daughter in 2010 that was never billed to the insurance company (figure it was part of the audit when the new company took over this medical facility). Our Primary paid even though it was over a year later but my secondary insurance will not pay. I called and informed the billing people that they were NOT getting money from me due to their untimely filing. I suggest contacting the hospital and discussing their untimely filing as well.

The woman I talked to with billing could not understand why the insurance was never charged and why I never received a bill.

As for those having an issue with you getting assistance and going to Disney, I would not even worry about them.

dcfromva
01-29-2012, 08:31 PM
Thank you for all your responses. I really need to learn to give more information...:rolleyes:

The reason I wrote here was because I have read many times how people have dealt with medical bills, not just paying it off, but negotiating and disputing.

And yes, I can pay it off, but I do not believe I owe it and will be calling first thing tomorrow.

The charge was for my daughter's birth almost 5 years ago. I was on Medicaid only at the time and in Ohio. In Ohio, the Medicaid program is ran through HMO's and the one I was assigned to covered 100%. I had no copay and the hospital was in-network. There was no anesthesiologist, so I don't have to deal with that. Unfortunately, because it was Medicaid, I never received a bill or an EOB, so I have no paperwork. What is really fishy is the hospital received a payment the day before sending me the bill.

So, aside from calling them, I have no idea what to do next.
I agree--I think you should call the folks who sent you the bill, if it still doesn't seem right then call the medicaid people in Ohio and ask for guidance. If it is a case of balance billing they may be able to offer some more help.

sookie
01-29-2012, 08:31 PM
If medicaid didn't pay the whole thing (part of it probably wasn't eligable?) then you owe the balance.
That isn't illegal, it's how insurance works and medicaid is like an insurance.

It is strange that they waited 4 years though. I would call and ask what it is because they should NOT be waiting that long to bill you. Unfortunately, there are rules on how long they can take to bill insurance, and it is written right into policies and the doctor's forms that you sign that if they bill late, you are still liable for it. Once I had a pediatrician "forget" to bill for my daughter's visit until after 90 days. Well, insurance only has to accept it up to 90 days after the date of service, so now I was liable for the entire visit. I had paid my copay on the date I was there. Technically, they were legally allowed to come after me for the balance. I acted like I didn't know that, kept complaining and they dropped it.

I would be worried about two things: is it fraud, and also - are they balance billing you?
If it is balance billing, that is illegal. In other words: Lets say the bill is 2000, but the medicaid contracted rate is 1500. Medicaid will pay 1500, and then the other 500 is forgiven under the contracted rate. If you have a copay, it works like this: If the hospital bills 2000, and the medicaid rate is 1500, and you have a 10% copay, you will pay 150 (10% of the contracted rate) and then medicaid would pay the remainder (1350). In that case, your liability is 150, not 600 (500+150) because of the contracted rate.
Call medicaid and get the EOB.

Another thing: they may not be able to legally come after you after four years - unless you make a partial payment, which would then restart the clock. If there has truly been no account activity for four years - look at your state and see what the statute of limitations is on this debt.

sookie
01-29-2012, 08:40 PM
And I have never known Medicaid to pay 100%.

In Oklahoma, for pregnancy, they will often pay 100% of the contracted rate, and many people don't even have a spend down (medicaid terms for a copay or deductible). I think almost 90% of my population that I care for in OK is on Soonercare.

1Mouse2RulethemAll
01-29-2012, 08:56 PM
Thank you for all the advice! I really appreciate it and I am very grateful for the kind words.:hug:

lilpig
01-29-2012, 08:59 PM
I also am from Ohio and have a background in medical billing. It is very important that you call them (hosp.) and speak to the person in charge in the billing department. Tell them the whole situation. Also if you have the name of your caseworker from when you were on medicaid, call her. It is easy to find their web-site, I am new so I dont know if I am allowed to put it here. You should not have to pay any out of pocket, unless they told you something before hand. Each case is case by case. Some have 100% coverage some have co-pays.

I feel bad that some felt the need to attack you. There are many situations in life that make people have to accept help. Then comes people who are nasty, and mean. Well..I feel sorry for them too because that kind of shallow darkness is hard to escape without truly wanting to change. And most of the time they are to self centered, big headed and miserable to do it. So in order to try and make themselves feel better they try and make everyone else look bad and feel bad. Please dont give them that satisfaction :rotfl:

duffy
01-29-2012, 09:01 PM
Just asked a question. And yes, one trip WAS a gift, the original poster says. The second trip was a stay at a deluxe hotel, yes, just after getting off Medicaid. She was able to not just get caught up with all her past bills, but to go on a trip with deluxe accommodations soon after.

That's some awesome budgeting skills.

bumbershoot
01-29-2012, 09:27 PM
It looks like the hospital is trying to get the balance from me that the insurance did not pay. I thought that was illegal.

You need to call Medicaid with that bill in your hand. (and the identifying info Medicaid will need of course)

Just like with any insurance, if there is a balance after the insurance has paid, you are responsible.

So NOT true in every circumstance. If the provider has contracted with the insurance carrier to NOT charge the extra, they CANNOT legally do so. If they try to, the patient is NOT responsible for it.

I once had a good day after getting a bill from a primary care physician, who was a preferred provider with my insurance company. She wanted me to pay what insurance didn't pay. I smiled, called the insurance company. They asked me to hold, they got on the phone with the doctor's office, and it was taken care of in under 5 minutes. Just because a doctor wants you to pay does NOT mean you're legally or morally obligated to pay it. If that doctor contracts with a company, they are legally and morally obligated to follow their agreements.

I would NEVER pay a $1500 bill that just showed up in my mailbox from 4 years ago without investigating it first.

Absolutely!


About 2 years ago a lab sent me a bill for something they did for DS, some little bit they hadn't charged at the time. I got the EOB at around the same time, and the EOB stated quite clearly that the entire charge was denied because it wasn't billed in a timely fashion, and stated that I wasn't obligated to pay it either. And i'm telling you that was around 6 months after service, not four years.

That's just common sense. A person should know to do that without asking random strangers on a message board.

Hospital bills are SCARY. Insurance, and especially insurance like Medicaid/care, is SCARY. Combine the two, along with something that happened 4 years ago, and you've got something that not everyone has encountered.

In Ohio, the Medicaid program is ran through HMO's and the one I was assigned to covered 100%. I had no copay and the hospital was in-network. There was no anesthesiologist, so I don't have to deal with that. Unfortunately, because it was Medicaid, I never received a bill or an EOB, so I have no paperwork. What is really fishy is the hospital received a payment the day before sending me the bill.

So, aside from calling them, I have no idea what to do next.

There is nothing to do aside from calling them, right now. Call them first. Then move on from there.

sookie
01-30-2012, 12:04 AM
Our 2006 trip was a wedding present, so we did not have to pay for that. My husband lost his job in early 2007 and I was in college. As soon as he had a new job, we got off welfare, which was well before the 2008 trip. Since then, I have graduated college and he and I work very hard for our trips.

There is no shame in getting help when you need it, and we needed it at the time. Now, we are productive members of society who pay our taxes to help others in need.

Bless your heart. That is exactly what it is there for. :grouphug:

badblackpug
01-30-2012, 12:56 AM
So, this was between the trip to the Polynesian Resort on your honeymoon in 2006, and the trip to the Wilderness Lodge in 2008?


I was thinking the same thing. State aid and deluxe accommodations? Shoot, I should quit my job so I can stop cramming my 4 kids into the ASMu family suites. :sad2:

Marionnette
01-30-2012, 07:19 AM
Bless your heart. That is exactly what it is there for. :grouphug:
That's exactly what I was thinking. The OP needed help during a difficult time. As soon as she was back on her feet, she got off of Medicaid. Why all the hating on someone who faced adversity and overcame it?

OP, call the hospital first and ask for a billing supervisor. Ask for a detailed bill that shows what was charged and what Medicaid paid for. It's very possible that somewhere along the line, they billed your old insurance instead. Especially since the bill is so old. They may have also coded it wrong and entered a code for something that Medicaid would not have covered, such as a cosmetic procedure.

I'm just astonished that they tracked you from OH to OK. It seems as if hospitals are getting desperate to recover unpaid bills. Good luck.

1Mouse2RulethemAll
01-30-2012, 07:48 AM
Thank you all. I called the hospital this morning and they are sending the bill back to the HMO to deal with. I guess it is a waiting game after that.




P.S. I do try to make good money decisions now-a-days, I just needed to find the budget board. :goodvibes

AftertheSunset
01-30-2012, 08:53 AM
Just asked a question. And yes, one trip WAS a gift, the original poster says. The second trip was a stay at a deluxe hotel, yes, just after getting off Medicaid. She was able to not just get caught up with all her past bills, but to go on a trip with deluxe accommodations soon after.

That's some awesome budgeting skills.

So you're ripping on the OP for 'not getting caught up' on a bill that she didn't even know about? Unreal!:eek:

duffy
01-30-2012, 09:14 AM
So you're ripping on the OP for 'not getting caught up' on a bill that she didn't even know about? Unreal!:eek:

No, I'm not. I presume she got caught up on all the bills that most people normally have. You know, utilities, rent or mortgage, etc. I never mentioned this specific bill-she didn't know about it-just "bills" in the general sense. I guess I presumed that if things were so tough, she'd have to get caught up on all her bills, not just some medical bill that she didn't know about.

My mistake, presuming she was not able to pay all her known bills promptly, despite being on Medicaid. The original poster could have been paying every bill right on time, and getting assistance too. I just presumed that if she was getting Medicaid, she had trouble paying other bills too.

I know that when I get enough money to do so, I pay back all my unpaid bills, at least the ones that I'm aware of! I guessed that the original poster did so too, when her situation changed enough for her to get off Medicaid. Not only paid off all her bills, but was able to spend extra on a trip to the Wilderness Lodge. Unfortunately, she didn't know about the bill for $1500, so couldn't pay it, of course.

Giving her the benefit of the doubt, she was given a stay at the Poly, followed by being able to qualify for Medicaid, still paid all her bills on time, and then followed up with a stay at the Wilderness Lodge. Years later, she got a bill for $1500 that she incurred while on Medicaid, and is letting her HMO handle it, based on her last post. AND is going to Hawaii next year!

Again, that's some mighty fine budgeting.

1Mouse2RulethemAll
01-30-2012, 10:13 AM
It's okay Duffy, I know you're not being mean. You're just having to look at an incomplete picture and its confusing.


The Hawaii trip is still in the planning stages, hence the question mark. We bought dvc a couple of years ago, (after we got our good paying jobs,) so accommodations are covered. But if the plane tix are too much we're going to scrap that trip.

My family is very frugal now, we have a budget we go by and save where we can. We also give what we can too. Our lives have done a 180 from that time and we are grateful.

Disney is our treat, when we can afford it; but bills and savings always come first.

DisneyMaMato8
01-30-2012, 02:00 PM
OP You are a lot nicer than I would be. I do think that Duffy is being mean, judgmental and very ichy.... You know what they say about karma. 's..'s..'s.

ccgirl
01-30-2012, 02:24 PM
It's okay Duffy, I know you're not being mean. You're just having to look at an incomplete picture and its confusing.


The Hawaii trip is still in the planning stages, hence the question mark. We bought dvc a couple of years ago, (after we got our good paying jobs,) so accommodations are covered. But if the plane tix are too much we're going to scrap that trip.

My family is very frugal now, we have a budget we go by and save where we can. We also give what we can too. Our lives have done a 180 from that time and we are grateful.

Disney is our treat, when we can afford it; but bills and savings always come first.

Op...you are MUCH nicer than me! I am the first one to be upset with those that mooch off the system. I drive by the projects every day to get to my house and some of them drive cars I could never imagine. HOWEVER, I believe it is there to use a stepping stone. Just like you did. And, I commend you for that. I was laid off twice in 2 years so I know what it was like. Luckily, we did not need welfare. However, I did need unemployment. And, I DID go to WDW while on unemployment. No, I did not collect the week I was gone. When I reported the next week and they asked if I was willing and available to work I answered truthfully, No. When they asked why I said I was on vacation. They thanked me for my honesty. When I did get another job, I continued paying in to my taxes as I always have. And, as I'm sure your DH had until he got laid off. I only hope those posters criticizing you don't fall on hard times. After all, they shouldn't be on the internet since it's a luxury. Shouldn't eat steak since it's a luxury. Shouldn't go on any vacations since they are luxuries, shouldn't let their children go on field trips or have any other activities since they are luxuries too.

I see you have contacted the hospital. It sounds like they billed you in error. It does happen. My children's dentist billed me for their cleanings. Heck, I am budget minded and didn't just pay it without agreeing to it. :rolleyes1 Turns out they forgot to bill my secondary insurance. It was their error.

OP - I congratulate you again and hope your good fortune continues.

bumbershoot
01-30-2012, 02:26 PM
Years later, she got a bill for $1500 that she incurred while on Medicaid, and is letting her HMO handle it, based on her last post. AND is going to Hawaii next year!

Again, that's some mighty fine budgeting.

You make it sound so nasty. But if she had an HMO at the time, they are the ones who should be dealing with it! If you have insurance, use it. If you had insurance and got a bill for that time, send it to the insurance company; they are the ones to deal with it!

It's not bad budgeting to want the companies you contracted with to take care of what they were supposed to take care of.

My FIL, back before I met him, had his own shipping business (like cargo ships type of shipping, not UPS Store). He had business insurance and lawyers and all of that. He incorporated to protect himself. He then did a favor for an old friend. He then retired and closed his business. Unfortunately, that favor was found out, and it got him (and the one he did the favor for) in trouble with the Malaysian and American governments, had to pay a bunch of money.

The act happened while he had insurance and lawyers. He SHOULD HAVE contacted his attorneys. Instead, he meekly surrendered his *paid off house*, the family home of his children. Just gave it over to the government. To pay off a debt that should NEVER have hit his personal finances at all. The whole point of incorporating and having protection of insurance is to protect parts of your life.

The point of having insurance is that THEY take care of these things, to the amount in the contract. And it's entirely appropriate for her to have it sent to the HMO, not just hand over the money like my FIL handed over their home.

duffy
01-30-2012, 03:05 PM
You make it sound so nasty.

Just stated the facts. Everything I said, is a fact that the original poster said first, or shows in her signature.

Swan4Me
01-30-2012, 08:30 PM
OP- or anyone- always question your insurance if it ever looks incorrect
This happened last month with my current insurance where they said I had incomplete coverage- even tho medical events the week before and after we're covered- causing this agent to re-run it and it was 100percent covered!!

sookie
01-30-2012, 10:42 PM
Op...you are MUCH nicer than me! I am the first one to be upset with those that mooch off the system. I drive by the projects every day to get to my house and some of them drive cars I could never imagine. HOWEVER, I believe it is there to use a stepping stone. Just like you did. And, I commend you for that. I was laid off twice in 2 years so I know what it was like. Luckily, we did not need welfare. However, I did need unemployment. And, I DID go to WDW while on unemployment. No, I did not collect the week I was gone. When I reported the next week and they asked if I was willing and available to work I answered truthfully, No. When they asked why I said I was on vacation. They thanked me for my honesty. When I did get another job, I continued paying in to my taxes as I always have. And, as I'm sure your DH had until he got laid off. I only hope those posters criticizing you don't fall on hard times. After all, they shouldn't be on the internet since it's a luxury. Shouldn't eat steak since it's a luxury. Shouldn't go on any vacations since they are luxuries, shouldn't let their children go on field trips or have any other activities since they are luxuries too.

I see you have contacted the hospital. It sounds like they billed you in error. It does happen. My children's dentist billed me for their cleanings. Heck, I am budget minded and didn't just pay it without agreeing to it. :rolleyes1 Turns out they forgot to bill my secondary insurance. It was their error.

OP - I congratulate you again and hope your good fortune continues.
I am the same way. I am the FIRST to get irritated usually, however - it is there for a reason!!
I volunteer and work with a lot of young girls who have babies. I tell them to get whatever assistance they can to get dependable childcare so they can go to school. I tell them to get the baby on medicaid so the baby can get good medical care. They need to do whatever they can to go to school so they can get a good job!! I tell them to use every single resource they can think of so they can pull themselves out of being in a place of dependence.
OP, you have nothing to be ashamed of!

Danibelle
01-31-2012, 04:59 AM
So, this was between the trip to the Polynesian Resort on your honeymoon in 2006, and the trip to the Wilderness Lodge in 2008?

This is an interesting thread. I was wondering the same thing.:surfweb:

Tinknalli
01-31-2012, 05:36 AM
I am a billing manager at a hospital so I do have some experience. One thing is that a bill becomes "stale" or uncollectible at 7 years, not 4. The other thing is that in some states insurance is offered to all uninsured people. Here you can get Medicaid (known as Dr. Dinosaur), VHAP or Catamount Plan HMOS and you are assessed a monthly premium depending on your household income.

The only way that the OP can get the right answers is from the facility. All kinds of factors could have caused the delay and could be anyones fault.

If she provided inacurate information might be her fault. If the facility dropped the ball, their fault.

eeyorethegreat
01-31-2012, 06:46 AM
:thumbsup2OP I would like to commend you on maintaining your "composure" and not feeding into the negativity in this thread. Well done. And bravo for dealing with your own hard times and moving on to help others through theirs!

familyoffive
01-31-2012, 09:05 AM
:thumbsup2OP I would like to commend you on maintaining your "composure" and not feeding into the negativity in this thread. Well done. And bravo for dealing with your own hard times and moving on to help others through theirs!

The strange thing about the Dis, stating an opposing opinion or view makes the thread a negative. Should people be doing handstands because the OP has been able to go on trips to WDW, hopes to go to Hawaii next year, and taxpayers paid for the birth of her child during a downtime? This is why our system is going broke, we don't hold people accountable. When we moved and our hmo didn't transfer, we paid cash for our child's birth, cash to the obgyn, had to prepay everybody before the 7th month. I'm sure that we would have loved to go to WDW instead of paying our share. Sorry OP, you have the money for DVC but want sympathy that the hospital is trying to bill you for $1500. You already have challenged the bill with the hospital and hope to get it "taken care of" by the hmo. Perhaps you could donate a like amount to a homeless shelter or home for unwed mothers.

eeyorethegreat
02-02-2012, 07:04 AM
The strange thing about the Dis, stating an opposing opinion or view makes the thread a negative. Should people be doing handstands because the OP has been able to go on trips to WDW, hopes to go to Hawaii next year, and taxpayers paid for the birth of her child during a downtime? This is why our system is going broke, we don't hold people accountable. When we moved and our hmo didn't transfer, we paid cash for our child's birth, cash to the obgyn, had to prepay everybody before the 7th month. I'm sure that we would have loved to go to WDW instead of paying our share. Sorry OP, you have the money for DVC but want sympathy that the hospital is trying to bill you for $1500. You already have challenged the bill with the hospital and hope to get it "taken care of" by the hmo. Perhaps you could donate a like amount to a homeless shelter or home for unwed mothers.

The system is going broke because there are people who use the system as a way of life. If it was used as it was intended as a short term stepping stone on a return to independence then there wouldn't be the major issues we have now and I doubt that there would be far less hostility towards people who have used things like Medicaid in the past. I say that coming from a place on both sides. Medicaid also paid in part for the birth of one of my children as well as the prenatal visits. That doesn't make me someone who sucked off the system, it was there when we were in need of it, we used it as intended and are no longer in need of it and haven't been for many years.

I also work in the school system. I can not tell you how many families I see who are life long abusers of the system. We recently had a family who was crying to the school that they needed money for heat. I have known this family for years in the school setting and they had been very open that they were in welfare system with me. The teachers took up a fund for them donated money in their name to a local oil delivery company. Never got so much as a thank you. It was also discovered that they get heating assistance as well. The kids came back to school after Christmas break raving about the Big screen TV and Wii and cell phones that mom and dad had gotten them. That is the kind of thing I take issue with. Not someone using the system appropriately as it was intended.

I don't get the feeling that the OP was using the system for anything other than what it was intended. I also don't get the feeling that if she is told that this balance is her's to pay that she will disregard it. It took four years for this bill to come to her. Any good consumer would be checking it out. She may find out that the bill was already paid and that during updating of software some statements were sent out that shouldn't have been. It is appropriate to ask those questions especially when a bill comes that far after the fact. She also stated that she does support casues for people who are not as fortunate as she is now. I didn't read the post as being an attempt to look for sympathy.

I know that there are people who come here "whine" about their financial troubles, ant sympathy and claim a trip was gifted to them. As a family who did have a WDW trip gifted to them (we went along with a relative who picked up the cost) when we couldn't have otherwise paid for it ourselves, I know it does happen. As often as stated on the DIS I don't know, but I was the recipient of a WDW trip. Our first trip in fact. We then saved every single penny we could to pay for our next trip on our own in full.

I also recieved a bill for services 3 or 4 years after the date of services. These services were through Child Development Services (Speech OT etc) for one of my children. CDS makes it very clear that their services are FREE to the individuals who are enrolled, regardless of their financial standing. The bill I got was for approximately $3000. I contacted CDS and the Billing department of the providers who were contracted for the services. I recieved the bill three more times after that. Could I have paid a bit here and there and just paid off the bill. Sure but the services were supposed to be provided free of charge at the time those services were given. It was not my responsibility to pay that bill and I didn't. I don't feel that I abused the system.

Familyoffive I am glad that you were in a position that you were able to pay for your prenatal and birth expenses out of pocket. Thats great! I also hope that should you be in the position to need asistance, that you do so responsibly and only for the amount of time necessary. I sure you would.

ETA Never in my life have I been able to do a hand stand or a cartwheel for that matter.

familyoffive
02-02-2012, 08:05 AM
The system is going broke because there are people who use the system as a way of life. If it was used as it was intended as a short term stepping stone on a return to independence then there wouldn't be the major issues we have now and I doubt that there would be far less hostility towards people who have used things like Medicaid in the past. I say that coming from a place on both sides. Medicaid also paid in part for the birth of one of my children as well as the prenatal visits. That doesn't make me someone who sucked off the system, it was there when we were in need of it, we used it as intended and are no longer in need of it and haven't been for many years.

I also work in the school system. I can not tell you how many families I see who are life long abusers of the system. We recently had a family who was crying to the school that they needed money for heat. I have known this family for years in the school setting and they had been very open that they were in welfare system with me. The teachers took up a fund for them donated money in their name to a local oil delivery company. Never got so much as a thank you. It was also discovered that they get heating assistance as well. The kids came back to school after Christmas break raving about the Big screen TV and Wii and cell phones that mom and dad had gotten them. That is the kind of thing I take issue with. Not someone using the system appropriately as it was intended.

I don't get the feeling that the OP was using the system for anything other than what it was intended. I also don't get the feeling that if she is told that this balance is her's to pay that she will disregard it. It took four years for this bill to come to her. Any good consumer would be checking it out. She may find out that the bill was already paid and that during updating of software some statements were sent out that shouldn't have been. It is appropriate to ask those questions especially when a bill comes that far after the fact. She also stated that she does support casues for people who are not as fortunate as she is now. I didn't read the post as being an attempt to look for sympathy.

I know that there are people who come here "whine" about their financial troubles, ant sympathy and claim a trip was gifted to them. As a family who did have a WDW trip gifted to them (we went along with a relative who picked up the cost) when we couldn't have otherwise paid for it ourselves, I know it does happen. As often as stated on the DIS I don't know, but I was the recipient of a WDW trip. Our first trip in fact. We then saved every single penny we could to pay for our next trip on our own in full.

I also recieved a bill for services 3 or 4 years after the date of services. These services were through Child Development Services (Speech OT etc) for one of my children. CDS makes it very clear that their services are FREE to the individuals who are enrolled, regardless of their financial standing. The bill I got was for approximately $3000. I contacted CDS and the Billing department of the providers who were contracted for the services. I recieved the bill three more times after that. Could I have paid a bit here and there and just paid off the bill. Sure but the services were supposed to be provided free of charge at the time those services were given. It was not my responsibility to pay that bill and I didn't. I don't feel that I abused the system.

Familyoffive I am glad that you were in a position that you were able to pay for your prenatal and birth expenses out of pocket. Thats great! I also hope that should you be in the position to need asistance, that you do so responsibly and only for the amount of time necessary. I sure you would.

ETA Never in my life have I been able to do a hand stand or a cartwheel for that matter.

You don't see a list of Disney trips, both past and future, under my posts, now do you? We struggled to prepay the cash for our firstborn. We went from an HMO to no coverage for an existing pregnancy in the third month. We had to make sacrifices and get the money together. As I wrote, the OP could donate that some to a shelter or charity that provides the type of services that she needed when she was given her medical assistance.

Marionnette
02-02-2012, 08:26 AM
You don't see a list of Disney trips, both past and future, under my posts, now do you? We struggled to prepay the cash for our firstborn. We went from an HMO to no coverage for an existing pregnancy in the third month. We had to make sacrifices and get the money together. As I wrote, the OP could donate that some to a shelter or charity that provides the type of services that she needed when she was given her medical assistance.
I think that it sucks that you fell thru the cracks but that is no reason to disparage the OP because she didn't. She used the system as it was intended, is back on her feet and is now able to afford more than just the basics in life. You have no idea how she spends her money other than the vacations that she has listed. Nor is it anyone's business.

ccgirl
02-02-2012, 09:38 AM
You don't see a list of Disney trips, both past and future, under my posts, now do you? We struggled to prepay the cash for our firstborn. We went from an HMO to no coverage for an existing pregnancy in the third month. We had to make sacrifices and get the money together. As I wrote, the OP could donate that some to a shelter or charity that provides the type of services that she needed when she was given her medical assistance.

And, how do you know she didn't?

Again, you don't know her circumstances. You don't know just how much hard luck they have had (nor do I for that matter). I certainly wouldn't feel that someone who had to rely on assistance for a short amount of time should be indebted to society for the rest of their life and never go for trips. Heck, I would bet some commenters get financial assistance (such as EIC) as well. Should those people then never go on vacation again because they "rely on the system?"

familyoffive
02-02-2012, 09:40 AM
And, how do you know she didn't?

Again, you don't know her circumstances. You don't know just how much hard luck they have had (nor do I for that matter). I certainly wouldn't feel that someone who had to rely on assistance for a short amount of time should be indebted to society for the rest of their life and never go for trips. Heck, I would bet some commenters get (such as EIC) as well. Should those people then never go on vacation again because they "rely on the system?"

Since none of us except the OP knows what took place, I was commenting based upon my own opinion and the statements the OP made in this thread.

ccgirl
02-02-2012, 09:57 AM
Since none of us except the OP knows what took place, I was commenting based upon my own opinion and the statements the OP made in this thread.

Okay, lets look at this another way. A family makes a good salary...pays their bills on time etc. They pay cash for some nice vacations and donate to charities. They are a one working parent household. That parent gets laid off, they went through their savings and go on financial assitance for a short period of time. During that time they do not vacation and live very frugally. Parent once again finds job, they get off financial assistance, begin giving to charity and vacationing again. Are you saying that family should not go on vacations since they once relied on financial assistance? Out of curiosity, would you pay a $1500 bill that your health insurance is responsible for?

angierae
02-02-2012, 10:14 AM
Okay, lets look at this another way. A family makes a good salary...pays their bills on time etc. They pay cash for some nice vacations and donate to charities. They are a one working parent household. That parent gets laid off, they went through their savings and go on financial assitance for a short period of time. During that time they do not vacation and live very frugally. Parent once again finds job, they get off financial assistance, begin giving to charity and vacationing again. Are you saying that family should not go on vacations since they once relied on financial assistance? Out of curiosity, would you pay a $1500 bill that your health insurance is responsible for?

This.

When I first started out, I was young, newly married, and pregnant. Both my DH and I were working full-time, but our jobs did not provide health insurance. Should I have gotten pregnant? No, it was an oops baby and we did the best we could. I got Medicaid, they paid 100% for my pregnancy and delivery.

Since then, my ex has gotten a good job and makes close to six figures, and I went to college, graduated, and am working and making decent money. Should we never, ever get to do anything with the money we worked hard to earn because 17 years ago we got financial assistance?

If the OP had taken a Disney trip in 2007, then I could see complaining. But a year later? After her DH was back to work? Why shouldn't they get to go on a vacation?