Hospital billing is ridiculous to deal with

kdonnel

DVC-BCV
Joined
Feb 1, 2001
Messages
7,244
My wife had surgery, all went well, on January 9th. I got a phone call on January 8th from the hospital pre admission department telling me it was an emergency they speak with my wife. I explained her phone does not work at work and they would not be able to speak with her until after 5pm. I asked if I could help and suddenly the emergency became well we just need some demographic information and a payment.

I paid the $4000 they demanded, the max out of pocket for her insurance, and the call ended, emergency solved.

On January 17th the EOBs from the surgery started dropping. Of course the surgeon had theirs approved first, then the hospital, and finally the anesthesiologist. That meant the hospital was only owed $2568.90 because the surgeon was owed $1431.10 of the max out of pocket and the anesthesiologist and any subsequent EOB just get the contracted insurance rate at no out of pocket cost to my wife.

I called the hospital on the 29th to see how long it would take to get the $1431.10 refunded.

While the billing department could see the credit, I was informed it would need to be investigated before refunded, a process that takes 2+ weeks(it had already been 13 days since they were aware of the credit), and then if a refund is really owed it would take another 7-10 days to generate a check, and then however long it takes for the USPS to deliver.

I explained I thought it was bordering on fraud that the hospital could take payment in 30 seconds over the phone when they were owed money but were telling me it would be 30+ days for them to refund money. There was nothing the phone agent could do so I asked to speak to a supervisor. I was told it would be 24 to 48 hours to get a call back. Before the call could end I asked to make sure they had my number for the call back as they would never be able to reach my wife. At this point the agent shutdown and said that actually he was not allowed to speak to me, only my wife.

I pointed out that the hospital had called me on January 8th and was more than happy to take payment from me, why was the hospital suddenly worried about patient privacy now that they owed money? I got no answer and the call ended.

A few years ago I had a problem getting a deposit refunded by a car dealer that should have been applied during the purchase and the only thing that helped was a BBB complaint. The organization seems old and out of date with the times but is apparently still a way to get companies to act.

I filed a BBB complaint against the Hospital immediately after the call.

Less than 24 hours later I got a response to the BBB complaint. The $1431.10 was being refunded to the same credit card used to make the payment. The hospital included a receipt of the partial refund of the initial payment. I should expect to see it on the credit card in no more than 3 days.

Why was that not the outcome of my initial call? Why did it take intervention from the BBB to shorten a 30+ day process down to less than 24 hours?

I have seen this before with doctors and dentists. They demand payment upfront and then are very slow to refund when it turns out insurance pays more than estimated. Sometimes they don't refund at all unless I demand a refund. Usually the office will say something to the effect of, we thought it best for the credit to remain at the office so that if you ever return you won't have to pay for that visit.

Are they holding onto the money to make some interest? Are they just so ill prepared to properly handle billing? Is it incompetence or done with malicious intent?
 
You are lucky you got it resolved so quickly. A few years ago our local hospital required a pre-payment that ended up being well over the actual amount. It took 2 months to get the refund.

As to "they can't speak to you" -- make sure your wife has you on file as approved to receive messages and discuss her treatment. Payment can be accepted from anyone but they need to have on record her approval to speak about details.
 
I thought that a durable PoA and/or surrogate health care directive(s) allowed the appointee to handle all medical related issues, including billing/payments/refunds? I know ours is structured in that way.

I tend to think a legitimate PoA, etc. would be sufficient to have them reconsider holding payments and the risk of taking potential legal action.
 
You are lucky you got it resolved so quickly. A few years ago our local hospital required a pre-payment that ended up being well over the actual amount. It took 2 months to get the refund.

As to "they can't speak to you" -- make sure your wife has you on file as approved to receive messages and discuss her treatment. Payment can be accepted from anyone but they need to have on record her approval to speak about details.
That's the thing. I am listed. That is why they had my contact info to get the pre payment. They just didn't want to refund the money as quickly as they took it.
 

They just didn't want to refund the money as quickly as they took it.
Right. Plus they want to make sure there aren't any lingering claims that haven't finalized yet. I'm surprised all her claims are fully processed so quickly as well. There's often 1 that lags -- which ones tends to vary in our experience. After our fiasco I informed the hospital billing department that we would not be pre-paying for anything in the future. There hasn't been another situation for me to test that, though, but it is a note on each of our records there.
 
Plus they want to make sure there aren't any lingering claims that haven't finalized yet.
Even if there were a dozen outstanding claims from the hospital the patient responsibility would be zero. She hit her max out of pocket between the surgeon bill and the hospital bill.
 
Right. Plus they want to make sure there aren't any lingering claims that haven't finalized yet. I'm surprised all her claims are fully processed so quickly as well. There's often 1 that lags -- which ones tends to vary in our experience. After our fiasco I informed the hospital billing department that we would not be pre-paying for anything in the future. There hasn't been another situation for me to test that, though, but it is a note on each of our records there.
Hospitals must vary. I had an out patient procedure on Wednesday of last week, and by the following TUESDAY I got an EOB from my insurance in the mail. Almost everything around here is nearly instant on billing. I had a major procedure 2 years ago, total billing over $200,000. Procedure was done on the 13th of the month, all claims made and paid by the end of the month.
 
The hospital won't just take your word for that. They'll require it to come through from the insurance company on any outstanding claims.
The hospitals claim is the one that told them the max out of pocket had been met and the patient portion had been reduced.

No need to take my word.
 
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I have long thought insurance companies are the customer, NOT the patient.

I had a doctor last summer want me to keep a credit card number on file, so that they could immediately charge you for any out-of-pocket costs. CRAZY!
 
Wow, I've only had experience with having to pre-pay up to our deductible, but never our OOP Max. I'm of the mindset that the hospital would not have refunded you had you not pursued it, and very likely make money off of people who do not have the time or are aware they are even eligible for a refund. Hospital billing is super sketchy. Twice now I've gotten the same bill for my son's NICU stay, waited to pay, and a few weeks later it disappeared with a zero balance, which has made me wary of any and all doctor and hospital billing.
 
The hospitals claim is the one that told them the max out of pocket had been meet and the patient portion had been reduced.

No need to take my word.
You said "Even if there were a dozen outstanding claims from the hospital..." and I replied "...on any outstanding claims."
 
I was hospitalized with Covid in 2020. The hospital had 2 doctors who cared for all the Covid patients. At the time, patients paid zero for Covid care. After I was released I started getting statements showing the amounts billed and that I owed zero, except for one bill, which showed I owed something like $500 for one of the 2 doctors. The date of service was right in the middle of my stay. All that happened was that it was coded incorrectly. I didn’t pay it but I called billing. The lady I talked to told me very sternly that it would need to be investigated and that takes time. Whatever. It was their mistake. But I was worried it would be turned over to collections.
 
My husband also just had surgery, and the day before his MRI they called for the $700 co-pay. They surgery was scheduled for the next week. A day or two before surgery we received communication that his surgery bill was sent to collections. A surgery that had not yet happened. When he called the medical facility they said that this is their policy and they do it for all patients. We did not appreciate this and do not plan to use this practice in the future.
 
My husband also just had surgery, and the day before his MRI they called for the $700 co-pay. They surgery was scheduled for the next week. A day or two before surgery we received communication that his surgery bill was sent to collections. A surgery that had not yet happened. When he called the medical facility they said that this is their policy and they do it for all patients. We did not appreciate this and do not plan to use this practice in the future.
That seems illegal. Certainly immoral.
 
I completely sympathize. This type of thing happens across the board, not just with medical. Businesses have no problem at all taking your money with the press of the Enter key. But then have all kinds of problems returning your money. And I agree that filing a BBB dispute helps get things resolved very quickly.
 
Similar thing happened to me when I delivered my son 18+ years ago. Hospital called the day before my induction, wanting a few thousand dollars to cover expected expenses. They then took forever to file with my insurance and the OB/GYN, anesthesiologist and pediatrician all filed before the hospital did, so the hospital bill was covered by my insurance as I had met my deductible. It took months to get the money refunded and I learned the important lesson of not paying before the procedure occurs. Glad you got your money back pretty quickly.
 
My wife had surgery, all went well, on January 9th. I got a phone call on January 8th from the hospital pre admission department telling me it was an emergency they speak with my wife. I explained her phone does not work at work and they would not be able to speak with her until after 5pm. I asked if I could help and suddenly the emergency became well we just need some demographic information and a payment.

I paid the $4000 they demanded, the max out of pocket for her insurance, and the call ended, emergency solved.

On January 17th the EOBs from the surgery started dropping. Of course the surgeon had theirs approved first, then the hospital, and finally the anesthesiologist. That meant the hospital was only owed $2568.90 because the surgeon was owed $1431.10 of the max out of pocket and the anesthesiologist and any subsequent EOB just get the contracted insurance rate at no out of pocket cost to my wife.

I called the hospital on the 29th to see how long it would take to get the $1431.10 refunded.

While the billing department could see the credit, I was informed it would need to be investigated before refunded, a process that takes 2+ weeks(it had already been 13 days since they were aware of the credit), and then if a refund is really owed it would take another 7-10 days to generate a check, and then however long it takes for the USPS to deliver.

I explained I thought it was bordering on fraud that the hospital could take payment in 30 seconds over the phone when they were owed money but were telling me it would be 30+ days for them to refund money. There was nothing the phone agent could do so I asked to speak to a supervisor. I was told it would be 24 to 48 hours to get a call back. Before the call could end I asked to make sure they had my number for the call back as they would never be able to reach my wife. At this point the agent shutdown and said that actually he was not allowed to speak to me, only my wife.

I pointed out that the hospital had called me on January 8th and was more than happy to take payment from me, why was the hospital suddenly worried about patient privacy now that they owed money? I got no answer and the call ended.

A few years ago I had a problem getting a deposit refunded by a car dealer that should have been applied during the purchase and the only thing that helped was a BBB complaint. The organization seems old and out of date with the times but is apparently still a way to get companies to act.

I filed a BBB complaint against the Hospital immediately after the call.

Less than 24 hours later I got a response to the BBB complaint. The $1431.10 was being refunded to the same credit card used to make the payment. The hospital included a receipt of the partial refund of the initial payment. I should expect to see it on the credit card in no more than 3 days.

Why was that not the outcome of my initial call? Why did it take intervention from the BBB to shorten a 30+ day process down to less than 24 hours?

I have seen this before with doctors and dentists. They demand payment upfront and then are very slow to refund when it turns out insurance pays more than estimated. Sometimes they don't refund at all unless I demand a refund. Usually the office will say something to the effect of, we thought it best for the credit to remain at the office so that if you ever return you won't have to pay for that visit.

Are they holding onto the money to make some interest? Are they just so ill prepared to properly handle billing? Is it incompetence or done with malicious intent?
Good for you on getting the $ back immediately! I've been down this road. I recently had dental work done and thought I had a credit due. The person that runs the office stated they would hold onto the credit for future use. I was ready to go to battle but decided to wait until I knew which way it would go. It turned out that my two dental insurance companies were battling it out. I ended up owing another $50! That being said I would have demanded the credit immediately if it had gone that way.

There is no reason for a medical office to refuse to credit an overpayment. It is not ethical or likely legal IMO.
 
every provider in my area does this - they NEVER voluntarily refund the overage. They won't even let you know there is one unless you specifically ask. Then they try to persuade you to leave it on file as credit. Then when you insist on a refund, it generally takes 6-8+ weeks or they conveniently lose the request and you have to follow up repeatedly.

Now that private equity owns most of the practices, the standard BS line is "I'll have to file a request with corporate".
 
Before prepaying for any medical care, contact your insurance company to see if the contract they have with that hospital or provider allows them to require prepayment. Chances are they don’t. If they do not, then tell the provider/hospital that you checked and your insurance provider says it violates their contract and ask them to send you the request in writing so you can report it to your insurance company. I have done this the few times this has happened and it was quick how fast they reversed course. I had the benefit of a career in healthcare finance administration, but most people don’t have that benefit.
 




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