Anyone do medical billing? Insurance related.

[Piecey]

I had my son in June. I/he had two forms of health insurance.
For our son DH's (GEHA) is primary and mine (UHCSR) was secondary.
Maternity (and newborn care in the hospital) is covered at 100% by GEHA.
GEHA discounted off about $300 of it (per their contract with the hospital) and paid their negotiated amount in full.


The hospital put the claim into UHCSR who refused to pay saying that there was nothing due. Which is what we thought, too.

The hospital keeps calling and saying that since we have TWO forms of insurance that UHCSR should pay because GEHA didn't pay the fully billed amount.

So... I'm getting really annoyed with the constant phone calls and letters saying that we have a balance. I've called the insurance companies and they usually get a little angry and promise to take care of it.. then I'll get another letter and it starts all over again.

Any idea who is right? The insurance companies saying that there is no further liability or the hospital saying that we still owe??

 

[Judy from Boise]

I vote there is no further liability. Your primary paid the contracted rate, thus 100% was paid.

 

[dapoteete]

If the hospital is contracted with your primary insurance, they can not bill you for the disallowed portions. I suggest you call your primary insurance company to discuss this with them.

 

[lsyorke]

You're done! Call the patient advocate at the hospital..they get things done!

 

[solotraveler]

If the hospital is contracted with your primary insurance, they can not bill you for the disallowed portions. I suggest you call your primary insurance company to discuss this with them.

Exactly this.

If your primary insurance only paid, say 80% of the allowable charges, then the secondary would kick in at that point. But since they paid 100%, you're done!

I would second seeing if the hospital has a patient advocate that you could speak to in order to get this resolved. If that doesn't work, you may want to take to your OB/GYN and see if they have a relationship with anyone at your hospital records and billing who could help get it straightened out.

 

[barkley]

this may be this issue (was with ours when both kids were born)-

kid's primary when their is dual coverage is based on parent with earliest month/date bday in year (so if dad's bday is say in may and mom's is in june, dad's become kids primary) BUT generaly, dual coverage does'nt kick in until the first of the month or 30 days following a newborn's birth. so until that time the child has single coverage under mom (and even if mom has dual coverage under self/her dh) it's ONLY mom that's covered by dad's part of the dual coverage NOT the newborn.


i'm wondering if dh's insurance covered mom only and they paid the "maternity and deliver" portion of the bill but did not pay the "newborn" items (with us it was the pediatiatric services) which would then get bumped into billing under mom's secondary (but for the newborn who until dad's coverage became effective for them-their primary).


find out who/what is being billed for-then find out whose coverage was effective for the period of time the billing occured.


in our case it went-

(maternity related billings) my primary paid first, my secondary next
(my child's related billings) my insurance paid first despite within weeks of the child's birth it becoming the secondary (because my policy covered my newborn until 1st of following month or 30 days to allowed me to add them to my policy or another).