Ugh, medical bills! WWYD?

[3boymthr]

I agree with the above post

also:
My insurance goes through periods when they reject every claim. As the insured I must call and explain to them why the service was needed and they often resubmit.

Neo- Natal bills are automatically rejected because they are out of network (there is no in network provider - they do not accept any insurance) and your child also has a Pediatrician. On appeal they are always paid.

It seems to be a game of cat and mouse. What can we get these poor unsuspecting people to pay for today?

For the birth of my first child I received a bill for $7000 for the assisting doctor on my child's 1st birthday. This was the first bill I received from this doctor. In the process of dealing with my insurance and her office I found out that she was scamming me and had already been paid by my insurance.
For the dame delivery which was a scheduled C- section I was billed for an epesiotomy sp?

Be careful call your insurance and the provider on every single claim

good luck

Really, they're are not out to get you. And Self-Funded Plans are not evil. Truly.

I've worked in insurance for 17 years now. The insurance companies are not out to get you. They do not reject claims just to see if the claimant pays them first. They can't. It's against the law. Insurance companies records are subject to review. They must pay what the contract says they will pay or they will lose their license to sell insurance. The Division of Insurance in your state is there to ensure this is so. If you have an issue with your insurance company rejecting your claims even though the contract says they should be covered contact the state Division of Insurance and request an investigation.

Insurance companies and self-funded plans are not evil. Self Funding is just a funding mechanism so that your company can charge you less money for your portion of the insurance. You can have coverage through Blue Cross or MetLife or Cigna or... and be on a self-funded plan (yes this is true I work with a client that has BCBS and is self-funded). Many, many, many large employers (1,000+ employees) are self-funded as well as a number of smaller firms. Self-funded plans are not bound by state laws as far as what benefits they have to offer, but they are bound by federal law (ERISA) so there are regulations in place to keep the plan honest.

Actually, in my experience, most often the issue is with the provider (Dr., Hospital, Lab, etc.) and most of them use third party billing companies who are paid by the number of bills that they generate. They often submit an incomplete or incorrect bill without the all the procedure codes, or diagnosis codes or with incorrect codes so the claim is rejected as incomplete, routine, etc. When an insurance company rejects a claim rather than checking why the claim is being rejected many billing companies will bill the claimant leaving it to the claimant to resolve the issue because they are not paid for correcting their mistakes.

 

[NotUrsula]

Also very important: remember that the birth of a child is one of the special circumstances under which you can adjust your FSA withholding in the middle of the year. If at all possible, raise what you are stashing in that account in order to shelter more of these expenses from taxes.

Be VERY careful if you ask the hospital to work with you and they want you to finance the payments on a hospital-issued credit card. Those are gaining ground now, but the interest on them tends to be astronomical, and they are normally NOT treated as medical debt by collection agencies, so if something happened and you got behind on the payments, it WOULD affect your credit score.

 

[3boymthr]

The neo-natal bills from the hospital were all paid as in network, the only bills we have to pay as out-of-network are the actual neo-natologists that treated DD. Thankfully what they billed was fairly small, and we only owe a percentage of those bills.


Yikes! Glad you got it cleared up and didn't have to pay, and hopefully that doctor lost her license for scamming patients! There really should be a time limit for billing, a few times we've gotten bills from doctors many months after the services happened, sometimes many months after we'd stopped seeing that doctor!

P.S. - For those who were talking about different types of insurance, we have a PPO. The "best" plan that my company offers, which is why I'm surprised by how much we owe out of pocket.

Check with your insurance company. Many times if a claimant goes to a network facility but received treatment from a non-network provider because they had no choice in the provider providing treatment the claim is paid at network levels. There are provisions in place in most contracts to this effect. Usually, for most plans I have worked with, these provisions are automatically in place for ER drs, Anesthesiologists (sp?). The same may be true for the neo-natologist. Pose the question in a scenario, i.e, "if I went to this hospital for emergency treatment and the doctor I receive treatment from wasn't part of the network would you cover it at network levels as I had no choice in the provider." If they say yes then ask "well, since I had no choice about receiving treatment from dr. x, why won't you cover it at network level?" If the customer service representative will not resolve the issue ask to speak with their manager. Pose it in the same scenario manner. You may very well end up with the claim covered at network level.

 

[Ava]

Check with your insurance company. Many times if a claimant goes to a network facility but received treatment from a non-network provider because they had no choice in the provider providing treatment the claim is paid at network levels. There are provisions in place in most contracts to this effect. Usually, for most plans I have worked with, these provisions are automatically in place for ER drs, Anesthesiologists (sp?). The same may be true for the neo-natologist. Pose the question in a scenario, i.e, "if I went to this hospital for emergency treatment and the doctor I receive treatment from wasn't part of the network would you cover it at network levels as I had no choice in the provider." If they say yes then ask "well, since I had no choice about receiving treatment from dr. x, why won't you cover it at network level?" If the customer service representative will not resolve the issue ask to speak with their manager. Pose it in the same scenario manner. You may very well end up with the claim covered at network level.

Thank you for this advice, I will do just that. When I saw the neo-natologist was out of network I did a double-take. How can that even be legal, for a network hospital to employ emergency service doctors that are not in network! Like I'm going to stop and say, "Wait, before you take my baby to the NICU for needed treatment, what are the names of the doctors who will be treating her so I can make sure they're in network?" Its things like that that make me hate (and try to avoid) doctors/hospitals/the whole healthcare system.

At least the anesthesiologist (sp?) who did the epidural sent us a letter saying they will accept whatever payment the insurance company gives them and not charge us anything additional. Why can't all doctors who work in hospitals be required to do that?

 

[mhsjax]

Just want to clarify, an insurance company is not a PPO or HMO. An insurance company offers different products. A PPO or an HMO is a product. I work for a major insurance company and a legit insurance company (i.e. not a self-insured employer or something) will have contracted rates.

I understand that, but there are still some out there that do not have PPO or HMO products, I work in insurance also. Also if they (for some reason) didn't go to a contracted hospital or one of the Dr's isn't contracted that can present a problem.

 

[bumbershoot]

I questioned how was I supposed to know that since it was an in-network hospital, and also asked what hospital in this area had in-network physicians. I was told that hardly any ER physicians are in-network- still no offer to adjust the claim. My next question was where was I supposed to go in a true emergency to be able to utilize my health insurance since there were no ERs around here with in-network physicians. It was only at this point that the insurance company rep said "we understand that & realize in this case you have no choice in the physician so if it's an in-network hospital we will re-process the claim and treat it as an in-network physician." It was obvious that although the insurance company's policy was to do this, the reps on the phone were trained not to immediately offer that resolution. The customer had to really question/complain about the bill to get the adjustment.

I'm so glad you got it worked out. I was not so lucky.

I had been working with homebirth midwives who hated me (whoops) and it became a battle during labor...they hadn't listened to me the whole time, why did I think they'd listen in labor...they pulled a highly illegal move (we're going to leave if you don't comply...can't abandon a patient especially in labor!) and got me to the hospital so they could be done with me. Nothing wrong with me or baby, we were perfect, but WA has laws about length of labor (that OR doesn't...it's just a stupid thing). The OB on call, yeah, we're not going to talk much about him, he was yelling "emergency" at me, finally got me to "yes", did his thing.

Then billed it as though I'd requested what he did.

And he was out of network in an in network hospital where every other little thing was in network.

And he didn't bill for OVER a year.

And then....he absolutely REFUSED to re-do his billing. Agreed that he said it was emergent care. Refused to change the code. I got to pay out of network when, according to him, it should have been In network b/c it was emergent care (according to him...for me, not so much).

AWFUL. But I'm glad your insurance was willing to re-do it without a change in coding. Mine wasn't.

Thank you for this advice, I will do just that. When I saw the neo-natologist was out of network I did a double-take. How can that even be legal, for a network hospital to employ emergency service doctors that are not in network! Like I'm going to stop and say, "Wait, before you take my baby to the NICU for needed treatment, what are the names of the doctors who will be treating her so I can make sure they're in network?" Its things like that that make me hate (and try to avoid) doctors/hospitals/the whole healthcare system.

If it's truly emergent care, it's not supposed to matter. As long as they code it correctly.

 

[KAMKIM]

I never even thought of asking for a discount. We do have the funds to pay now (in savings) so this is another option for us. Thanks for the idea!

Disneychix, we do have to pay a co-pay for DD's well-visits/immunizations. We also have some other medical expenses (prescriptions, contact lenses for me, etc) that we usually use our FSA for. So I'm sure we would use up the money before the end of the year.

Aurora & nuttypretzel (love the name, haha!), we've gone over all the bills and have spoken to the insurance company to make sure everything is correct and we understand what we owe & why we owe it. We hadn't paid anything towards our deductibles yet for the year, so we owe those plus our 20% co-insurance. We are disputing my partner's bill with the hospital - they have her discharge date down as 5/3, when she was actually discharged on 5/2. Only the baby stayed until 5/3. My partner did stay until after the hospital's usual discharge time for maternity patients because the baby was still in NICU, so we might have to pay for the extra day anyway, but they are pulling her chart and are supposed to call us back next week. And our pediatrician's office has tried to bill us for things before the insurance co has paid their portion; I haven't gotten to them yet, but I do plan to call and tell them no way - you bill me AFTER the claim is processed by insurance. Believe me, I won't pay any bill until I'm sure that it's legit!

Def call and see if you can reduce the bill - I had an outstanding bill from years ago and they dropped it almost 50% seriously just because I asked them to.

 

[disneyatl]

Call the hospital and let them know you are unable to pay the full balance at this time and would like to set up arrangements (have an idea of what you are able to pay per month handy when you call). Write a follow-up letter to the hospital outlining your conversation. Keep a copy of everything you send. When the hospital deposits the check, they have automatically agreed to the terms of your letter. Pay monthly payments until the balance is paid off. I've done this several times with medical bills we haven't been able to pay and have had no problem. You can even find sample letters on the internet. If you get a letter from a collection agency, send a copy of all your documents with another letter stating you've made prior arrangements with the hospital and tell them never to contact you again regarding this debt. You can find out a lot of information on debt collection at clarkhoward.com.

 

[toobie75]

Congrats on your new baby!

First and foremost call the hospital and ask them for a line-by-line itemized bill. Then go over it with a fine tooth comb. They make mistakes just like anyone else (a friend of mine was charged for a circumcision when she had had a GIRL!). Then call your insurance company and find out what they didn't pay for and why. There again, they can make mistakes and you can always appeal what they decide. After that call the hospital back and ask if they have a cash or pay-now discount. Sometimes they will knock off a % if you pay your balance in full. You can also haggle with them on the price and just flat out ask if they will take less than $10 for those 2 Tylenol you were given for your headache (I'm totally not joking on the price here). If you can't pay in full, see what type of payment plans they offer. If you get multiple bills from multiple providers you will have to do the same thing with them.

My grandmother had a brain bleed in March and was in the hospital for a month. Her itemized bill was 63 pages long, $250,000, and there were a LOT of mistakes. They tried to charge her for 4 more units of blood than she was given, they charged her for PT and OT when she was in a coma in ICU, they charged her multiple times for procedures that only happened once, etc. We ended up reducing the bill by $6,400 just by clearing up their mistakes. In the end that was a drop in the bucket but still...your money is your money.

 

[polineedyan]

I would, flame suit on, recommend you go to the local department of family services. Once you deplete your assets, they may pay the rest of the bill.
I would, and this may have been suggested, call and ask for a reduced rate. A lot of hospitals have that option, especially if you meet the poverty criteria. Assuming you dont, I would ask to make a percentage payment. I have been told by medical billers that 10% of the balance per month is reasonable. They have done that for me. Congrats, and BTW, youve only just begun...

 

[DisneyShannon]

I just found out I am diabetic and I just got the blood work bill for 9 hundred dollars. My insurance pays all but 100 dollars of it. Seeing everyones story I was charged 14 dollars for the needle they use to get the blood out of your vain. Hope it works out.

 

[CharacterFan]

Thank you for this advice, I will do just that. When I saw the neo-natologist was out of network I did a double-take. How can that even be legal, for a network hospital to employ emergency service doctors that are not in network! Like I'm going to stop and say, "Wait, before you take my baby to the NICU for needed treatment, what are the names of the doctors who will be treating her so I can make sure they're in network?" Its things like that that make me hate (and try to avoid) doctors/hospitals/the whole healthcare system.

At least the anesthesiologist (sp?) who did the epidural sent us a letter saying they will accept whatever payment the insurance company gives them and not charge us anything additional. Why can't all doctors who work in hospitals be required to do that?

My fiance had the out-of-network issue with his insurance. He needed emergency appendectomy, and the doctor that the hospital assigned him was out-of-network. He wrote the insurance company and they agreed to review it as in network.

 

[Planogirl]

Whatever happens make sure that you stay in contact with the medical facilities where you owe money. These bills likely won't go to collections if they continue to hear from you. Some people say that they planned to talk to the hospital or doctor "sometime" and then they are puzzled as to why the bills ended up in collections.

 

[dyna]

A few years ago we had a sick child that was in an out of hospitals an rehabs more times than I can remember for almost 2 yrs. Our insurance has a 100,000 limit per year. Both years we came within about 2,000.00 of that limit Our out of pocket expenses was40,000 1 year an 30,000 the other year. DH cashed in his 401K paid off what he could that 1st year. The hospitals was wanting bill paid in full within 3 months each time. Threating to turn DH into collection agency if not paid in 3 months My stubborn DH would not call hospitals an try to make payment arrangements or see if they had a low interest line of credit he put the bills on CREDIT CARDS!!!! I knew then that was the wrong thing to do.

This past winter when the heat pump went out he could not get a loan because he owed to much in credit cards paying the minium payment on plastic gets you NO WHERE!
DH ended up taking out a home equity load on my house that was paid for which I did not like but had a couple of advantages I could live with which was.

Now that the credit card bills are on home equity loan an dh took out the insurance if he dies the bill is paid off good deal since he is 62 yrs old an has outlived everyone in his family already an his family dies suddenly with no warning at a young age.

We now make 1 payment a month an it is a payment we can live with if DH decides to retire before it is paid off.

DH makes double payments on the loan for now until he retires.

DH still has money to put in savings account weekly an while we not living high on the hog we have more money to do more things with than when he had all those credit card bills.

The draw back tho is if we was to sell house today an move we'd pay out 80% of the value of home to pay off the home equity loan which rips me to no end since the house was once paid for. The past year we have had family issues that makes us want to retire sell house an move far away from family. I keep telling DH to do it he says I'll thank him when I'm 80 an get more money than if he was to retire today.

Do what ever it takes to pay the hospital bills DO NOT put them on plastic!!!! I'd take the chance of bad credit before putting them on plastic.

OHHHHHHHH an the same child we spent all that money on is also the same one who is giving us much much stress an grief today to the point that it has split the family apart she is now 18 has accused of many horrible things taken out a protective order against us. NOT only accused us once an reported to the police but 3 times in a year. The child needs mental help isn't getting it no one in family can have contact with her to get her the help she needs the womens shelter she went to was only feeding her the so called abuse she claims she has had an what she should do about it. They will not talk to us there we have sent ministers there to try to work this out an other family members who are licensed therapist for them to only be turned away told that the facilaity can not say whether or not DD is even there. DD eventually moved a 100 miles away to live with a friends aunt till she starts school in August. The lady she is living with called yesterday told my oldest DD that her sis is now ready to drop the PO an wanted to come home against DH's an I's wishes an threats DD went got her took her to our other DD's home till the issues can be resolved an she can move back in with us.

It sounds terrible but we have been thru so much the past year that we don't want her back living with us. At the age of 18 we can no longer put DD in the place she needs to be she has to do it herself. Even if we made her go if she did not want the help it would be a waste of money.

On top of that we can get in trouble cause the other DD's are breaking the PO even tho we had nothing to do with it. MUCH MUCH more stress DH an I don't need in our lives.

DD accused us of very horrible things one so hideous I can't believe anyone believed it. An had anyone told me that it had happened I'd have asked to see the scars an doctor bills.

I was accused of getting mad at DD an cutting her toes with a filet knife....funny thing is I still have all my teeth an never washed no bloody socks an in court DD herself said she had never had trouble walking from the cuts or went to the doctor. Yet the PO still stood an the accusation was not dropped.

DH an I wishes DD a good life hopes she does well but we not wanting her back in our home NEVER EVER thought I'd feel that way about a child that I raised but I never thought one of mine would accuse me of cutting up her toes either an like I said the other things we was accused of was much much worse.