Need to vent - Warning LONG!

[Rafikifan]

I assume that this is the place for off topic discussion and I need to vent. DH and kids aren't home and neither are any of my friends. I'm housebound with a sinus infection and so I am relying on my DIS friends to calm me down. In March of 1999 yes 1999! my dd woke up one Sunday morning "cold" symptoms and fever. Even though I was giving her children's Tylenol and Motrin, the fever kept going up and up and it started to scare me rising so quickly so we took her to the local hospital's emergency room.
They gave her more Motrin, did a chest x ray, and a shot. The bill was over $600. We had really good insurance at the time and our E.R. co-pay was only $50. so I paid it as soon as I received the bill. No sweat since our insurance co. always paid promptly. I kept receiving a bill from the hospital for the amount with my co-pay deducted and then my explanation of benefits came from the insurance company showing they paid only 2 checks for minimal amounts - one $21 and one 40 something. There was no explanation why the other things weren't paid so I called the insurance company. They said they had no record of a claim in that name. HUH? I said, "How could you have paid 2 checks to the hospital which is stated both on my explanation of benefits and on the hospital bill if you have no records of the claim?" They told me to ask the hospital to fax a copy of the emergency room records which I did. Next month, still bills coming. I call the hospital again and to try to make this not so painstakingly long, the bottom line is I called every month for almost 2 yes 2 years and EVERY time the lady I talked to in billing said for me to NOT worry about it, I had paid what I was responsible for, that she saw the record that the fax they sent the insurance co. had been received but there was no response, even to say why they might refuse to pay. She even knew me by name I called so much. Finally when it was approaching 2 years I said enough is enough and she assured me she would have her supervisor call me within a day or two. I never got called. I called back AGAIN and she said she would relay the information again and that no matter WHAT I was not responsible for the balance and it was between the hospital and the insurance co. to settle. I didn't receive a bill again - 3 years and NOOOO correspondence in any way. Guess what I got in the mail TODAY FIVE years and 27 days after this ER visit and 3+ years since I've gotten a bill? A notice dated on April 12th saying that withing 7 days we would be turned over to their collection agency. I SPECIFICALLY told the lady in billing that I apologized for hounding her every month about this but I wanted this staightened out! I do NOT owe this money. Now the trick is how to prove it since I will have to dig through countless boxes to find statements from FIVE years ago and the lady in billing (I wrote her name down IF I can find the bills) may not even work there anymore much less recollect all this. I guess although frustrating it's just as well they are closed today because I might threaten bodily harm! (JUST jokin!! But I am angry!) I pay what I owe but I will hire a lawyer for the first time in my life if they don't take care of this right away. What would y'all do?????? Thanks for listening!

 

[Serena]

OMG!!!

First of all, I am sorry you're sick. I hope you are feeling better soon.

As for the bills, I wouldn't know where to even start on something like that, it's awful.

 

[CajunDixie]

Not flaming but you should have been calling the insurance company for those 2 years. I currently do billing and once the insurance company has paid I send a statement with balance due to the PT. Incuded on this statement is the payment the insurance company made and a statement saying the PT is responsible for the balance of the bill. Although, if they call and specifically ask me to rebill the insurance company at the insurance companies request I will do that. The hospital employee should never have told you it was ok. The first thing you need to do is dig out the EOB (explanation of benefits) and the original bill. Call the insurance company Monday morning and make them take care of this ASAP. You most likely will need to send a copy of the EOB. It's not the hospitals responsibilty unless they billed it wrong. There are soooooo many different insurance companies out there and sometimes you get a ahhhhhh ignorant adjuster that nitpicks how the bill is read and refuses to pay part of it for some reason only known in their own warped brain. As for the hospital employee.....I highly doubt you could pay an employee to continuously fight insurance companies.....only you know what your exact coverage was.

Recently I had a claim refused because the insurance company said the PT could have been transported by private vehicle. Ahhh lets see the PT is physically and mentally retarded and was on O2 and a monitor. And the trip was over 100 miles. Needless to say I rebilled the insurance company and sent them a copy of the run report.

 

[Microcell]

I do billing as well and agree that you may just be a victim of whatever yahoo at the insurance company decided what to pay. I really think they throw a dart at the number sometimes. I would talk to the billing dept at the hospital and get those statements out for proof. They should have long since written it off. They should not be trying to hold you accountable five years later. There should be notes on the hospitals end of all the communication between the two of you!

 

[chager]

I went through something similar with a hospital. The difference was we had qualified for reduced rate counselling for our son at the time. (DH was unemployed due to his company closing) The billing department had ALL the paperwork. They told me they did. They even had 2 copies of it because I sent them one and gave the counsellor one. Well 3 months after everything was "fixed" I get a bill for almost $700. It was the difference between what I had been qualified to pay and the full charges for the visits. I call the billing department. Play phone tag before talking to the woman and being assured that we owe nothing and the charges were being recoded the proper way. Following month repeat all the previous. This continues for almost a year. Then I'm told it is corrected. 6 months pass....another bill Threatening collection now. I call and talk with the SAME woman and again told that everything would be fixed. I call back 2 days later to verify it is fixed. Well evidently they are being audited and my file is not there because it is in the womans TRUNK!! At this point it disappears for 3 months!! I am finally told it was fixed. I asked for a statement but have not received it as of yet. As of Nov the woman has not even returned my phone calls! I am praying it is taken care of. I'm thinking I may add it to my To Do list to follow up on again next week

Good luck!!

 

[kadaten]

Originally posted by Microcell
I do billing as well and agree that you may just be a victim of whatever yahoo at the insurance company decided what to pay. I really think they throw a dart at the number sometimes. I would talk to the billing dept at the hospital and get those statements out for proof. They should have long since written it off. They should not be trying to hold you accountable five years later. There should be notes on the hospitals end of all the communication between the two of you!

Well, they do try to hold you accountable. When I went to buy my first house in 1999 they pulled my credit record and said I had a "charge off" (unpaid bill that was written off as never collected) from a hospital bill in 1992. Well there were a couple things wrong with that: First, I was a MINOR in 1992, and was not responsible for my medical care!! Second, when we called the hospital, they said that bill had been paid in full in 1993....deducted from my mother's paycheck since she was a hospital employee. Third, it was for a measly $35 co-pay (they didn't collect up front then...you were billed for your co-pay later). I couldn't believe my credit was at risk for something SO riddled with errors!!

My advice to you...call the insurance company, since it's their part of the payment that's being disputed. Actually, I'd put it in writing and save copies of everything. Most companies have a mandatory response time....I think ours is required to respond to anything within 30 days and it's supposed to be resolved within 90 days, but only if it's in writing!! Good luck!!

 

[one_cat]

I've been through this kind of thing too, though not as bad. It took me hours of phone calls to the insurance company and the clinic for over a year to get it straightened out. Then when I thought it was all done and fixed, months later I got another bill - we will be turning you over to the collection agency unless this is taken care of immediately. Boy did they hear from me Monday morning... They time these things to always come on Saturdays. I had the lady I talk to send me a LETTER of apology that included the fact that the bill had been completely satisfied and that I owed no money. Considering the fact that it had resurected once I was under no illusions that it would not come back to life again. I second the motion that you contact your insurance company. It took a very patient insurance person talking to the clinic with me listening to get everything straightened out the first time. Every time I talked to the clinic I informed them that billing me was a waste of time. They would NEVER receive another check from us, and they will never hear from us again as a patient.

Good luck. I'm sure you will work this out.

 

[GoodFairies]

EOBs almost always have codes on them which explain why the insurance company paid the amount that they did. It isn't necessarily true that "you do not owe them any money" if you don't know why the insurance company only paid part of the claim. They can reject for any number of reasons. It is possible they made an error but you will need to look at your EOB and call the insurance company.

In order to stay out of collections, you should pay the billing company ASAP. Then find out if the insurance company will pay more on the claim. If they do, the billing company will then issue you a refund. It's a hassle but if it's the way to keep you out of collections, then you should do it.

I am not sure if it is the same everywhere, but the hospital where I used to work could not legally send a person to collections as long as they were making minimum monthly payments. So if you can't pay in full ASAP in the seven days you could try calling the billing agency to see if they can put you on a payment plan, and then you could make small payments while you try to work it all out with the insurance company. If the insurance then does pay the remainder of the claim in full, you will receive a refund from the billing agency for what you did pay.

GOOD LUCK!

 

[Southern4sure]

To make a long story short.......basically the same thing here...except it was the hospital's fault. I was turned over to a collection agency 2 years after I paid my copay. The insurance co was on my side and was calling the hosp, sent faxes of the checks (they paid the entire amount). The collection agency wouldnt hear of anything I said. I spent hours and hours for two 1/2 yrs refusing to pay something that I have proof was paid. Hospital wouldnt talk to me because it was turned over to a collection agency and so forth, so I argued, cried, demanded and whatever else fit to clear this up. The Col. agency didnt care....was soo rude, like I was lying it was my fault and I was trying to skip town without paying for the service. Finally, the hospital called me and told me they applied my ins. payment to someone else's account and was sorry for the problems that I incurred. I cannot say enough how the Insurance co. went over and beyond to help me clear this up. They suggested I file a grievance with the hospital, (which I didnt know could be done) and it worked.

Dont give up......keep all paper work.......and fight for what you know is right.

Southern4sure

 

[Rafikifan]

Originally posted by CajunDixie
Not flaming but you should have been calling the insurance company for those 2 years.

Not taking it as a flame at all and I appreciate all your responses. If this was something that had happened even a year ago it would be easier to handle. But here it is 5 years later! Dh's employer has changed insurance companies twice since then and my fear is that since they were so unhelpful then, I can only imagine what it will be like now. After being told by the hospital billing office that I would continue to get a bill until the insurance co. paid, then she passed it on to a manager and then I stopped receiving any statements from the hospital so of course I assumed that they had settled with the insurance company especially since I haven't received a bill in 3 years. I'll let y'all know how it turns out!

 

[Pin Wizard]

If you paid your co-pay, ie, $50, you're not responsible for the rest. It's a shame you're stuck in the middle between the hospital and your insurance company. I once had surgery and paid the co-pay. I don't remember, but I'm sure I got an EOB showing what my insurance company paid...they were always so good! (Unlike my present company who has NEVER sent me an EOB.) Six months or so later the hospital sent me a bill and said my insurance company never paid. Ha! The hospital sent them another bill, and they actually paid them again! After that the balance was written off. Strange.

 

[BuzznBelle'smom]

Your post brought back memories!! Poor Buzz is my "high maintenance" kid--multiple ER visits, etc. You're going to have to bite the bullet, sift through your paperwork, and get on the phone tomorrow, not stopping until you've resolved this. Sorry, no other way!

Chalk it up to lessons learned--I had bills I would still be fighting 2 years later. I learned to (a) follow the HMO procedures to the letter (calling them from the ER, etc.), (b) save every receipt, and (c) call as soon as I got a questionable bill in the mail. I had all sorts of stuff rejected at first, but never lost a fight because I was always prepared with my paperwork. (Not saying I didn't have to pay stuff--I'm happy to pay what I owe, but always got the insurance co. to kick in what they should)

 

[Rafikifan]

I'm the O.P. and wanted to share my good news with all of you. I couldn't call about the insurance issue until the afternoon since I had to sub for the secretary at school all day but as soon as I got home I got on the phone. First I called the phone # that was on the "you will be turned over to collections in 7 days" notice and spoke to a rep. who then turned me over to her supervisor. She explained that they weren't actually the hospital (even though on the return address said it was the hospital) but that they were an "agency" who represented the hospital. She was very nice but she basically said that the hospital should never have told me not to worry about it because they couldn't gurantee that and insurance company will always pay and of course wanted the name of who I spoke with but like I explained, at one time I had the lady's name written down but that was THREE years ago and since I THOUGHT the matter was resolved I didn't keep her name. She said she would check into it and get back to me. I hung up and called the hospital directly and asked for the business manager. She was very sympathetic as to my situation and said she saw on the computer what I had paid, the ins. co. had paid and that they were battling with the ins. co. She apologized profusely and said that she would call the company herself and it would be taken care of. As nice as she was I was skeptical since I had been told that already over a dozen times. First thing this morning I got a phone call from the woman I had spoken to with the AGENCY and she asked, "Did you have communication with the hospital yesterday because it's the weirdest thing. I pulled up your file and some time yesterday they have you cleared out with a $0 balance and have noted that the claim has been paid in full." I asked again, 'Are you SURE, this is it, the account is cleared?" "Yes, it's cleared." Of course now I know that no matter how long goes by KEEP receipts and records of ANYTHING involving insurance! Thank you all for listening to my woes. I feel like a weight has been lifted off my chest!

 

[EsmeraldaX]

Which insurance company is this? I am having similair problems with mine (United)

 

[The Mystery Machine]

Wow! Good news for you!

I had something similiar but in my case we had a collections bill come in the mail completely OUT OF THE BLUE after 2 yrs!
It was for labwork. Apparently the lab had billed the "WRONG" insurance company. My husband worked for a hospital and then had changed insurances twice mind you, and it was the same insurance company but a different plan. Confused?

No notice, no warning...it does happen. We paid it, what choice did we have? Since it was "labwork" they don't have to be under the same rules about payment.

Now when I get labwork I make sure they photo copy my card.

 

[Rafikifan]

Originally posted by EsmeraldaX
Which insurance company is this? I am having similair problems with mine (United)

Oh my word! EsmeraldaX, the insurance company that did this was United Healthcare.

 

[CajunDixie]

." I asked again, 'Are you SURE, this is it, the account is cleared?" "Yes, it's cleared." Of course now I know that no matter how long goes by KEEP receipts and records of ANYTHING involving insurance!

You need to do 2 more things. First have either the "agency" or the hospital send you a statement that shows the bill was paid in full. Second you should really check your credit report in case the "agency" reports to a credit bureau. If it is on your report it'll be easier to get it fixed now rather than in a few years if you need credit for something like a loan or mortgage.