Medical Bill help

[momto2inKC]

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]

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]

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]

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??

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]

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]

Thank you for all your responses. I really need to learn to give more information...

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]

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]

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]

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]

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.

 

[1Mouse2RulethemAll]

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]

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]

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

Exactly!!

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??

 

[angierae]

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]

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]

Thank you for all your responses. I really need to learn to give more information...

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]

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]

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]

Thank you for all the advice! I really appreciate it and I am very grateful for the kind words.

 

[lilpig]

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