[2011] Hospital Bills/ Insurance denied ??

markel · Jun 2, 2011

Hi,

I have a friend who asked me (for which I do not know the answer) if there is a minimum you are required to pay a hospital bill for which insurance denies?? She is hoping for some advice before calling the billing office for fear that they may "push" her into higher payments then she can't afford. Is there a specific period of time that a balance needs to be paid in?

Thanks, Mark

MelBay · Jun 2, 2011

Oh my, there are a bazillion variables that can impact this answer. If it were me, I'd call, say "Because insurance didn't cover this, and I expected them to, I am totally unprepared to pay this bill in full at this time. I will give you $xxx now, and pay you $xx a month for xx months." Low ball it, because they will counter with something higher, obviously.

And, if I were her, I'd figure out what her insurance WOULD have paid had they covered whatever it was. For example, when DH had chemo, each session was $15,000, but insurance paid $8,000 because we went to a Preferred Provider. And the Oncologist accepted that reduced amount without batting an eye. So your friend should roughly calculate that pie-in-the-sky amount and finish her offer by saying: "Blue Cross (or whomever) would have given you $xxx, and you'd have accepted that as payment in full. I'm prepared to do the same."

Or something along those lines. Again, it all depends on the hospital, their policies, laws in the state where you live, etc.

Make sense?

Rose Pink · Jun 2, 2011

Makes sense to me and that is the same advice I'd give.

markel · Jun 2, 2011

Yes, makes sense. I was thinking the same thing as you as offering what the insurance company would have paid to the hospital, I just didn't want to give her bad advice. Reality of it is, it's around $1000. That may not sound like alot to some, but to others it is. Her insurance is very good and for some reason they denied this claim, the first time she says has happened??? Anyway, thanks for the advice. I will let her know. I know my oldest daughter had a spinal fusion 4 yrs. ago. The hospital (different one from the one in question) billed roughly $135,000 for the procedure/stay. The insurance co. paid roughly $35 K when all was said and done. So, maybe she can get off with paying less then the $1000.

Mark

MelBay said:
Oh my, there are a bazillion variables that can impact this answer. If it were me, I'd call, say "Because insurance didn't cover this, and I expected them to, I am totally unprepared to pay this bill in full at this time. I will give you $xxx now, and pay you $xx a month for xx months." Low ball it, because they will counter with something higher, obviously.

And, if I were her, I'd figure out what her insurance WOULD have paid had they covered whatever it was. For example, when DH had chemo, each session was $15,000, but insurance paid $8,000 because we went to a Preferred Provider. And the Oncologist accepted that reduced amount without batting an eye. So your friend should roughly calculate that pie-in-the-sky amount and finish her offer by saying: "Blue Cross (or whomever) would have given you $xxx, and you'd have accepted that as payment in full. I'm prepared to do the same."

Or something along those lines. Again, it all depends on the hospital, their policies, laws in the state where you live, etc.

Make sense?

Rose Pink · Jun 2, 2011

Does she know why the claim was denied? Sometimes it is a coding error and if the hospital is made aware, it can be fixed and then the insurance company will pay.

I've disputed claims and won.

markel · Jun 2, 2011

That's the thing. She's called the hospital about the "code" they submitted. They are unwilling to help. I told her that if that's all the hospital is willing to do (to get their $$$) then only offer to give them a few dollars/month. Maybe after she contacts them they will think differently. I just don't know whether it's proper (or even allowed) to tell them "I'll pay you $10/month until it's paid off" Now, I think she can afford a little more than that, but it's about the principle.

She has told me what the claim was for. She had her PCP submit documentation stating that they felt this necessary. My wife is in her last semester of nursing clinicals and thinks the same. Ins. Co. says no??? That's why I think paying a very low monthly amount in protest is in order.

Rose Pink said:
Does she know why the claim was denied? Sometimes it is a coding error and if the hospital is made aware, it can be fixed and then the insurance company will pay.

I've disputed claims and won.

Rose Pink · Jun 2, 2011

Whether the coding was wrong is not the same as having correct coding and having the insurance company deny it. Just because a PCP has indicated something is necessary doesn't mean it is covered. Your friend needs to check her policy very carefully.

As I mentioned, sometimes you have to fight the insurance company to pay for what they are supposed to pay. Sometimes you have to fight the provider to get the coding corrected. (I had to literally sit in the insurance company's office and have the insurance company call the provider to correct the provider's coding. It was a huge hassle and took many phone calls but finally it got changed and the insurance paid.)

It's tough being the patient. You are responsible for the bills. You pay the insurance company, you jump throught the hoops and still have to fight sometimes. Even though the patient is responsible for the bills, the patient is at the complete mercy of the insurance company and the provider. You can't fix their mistakes yourself. You have to nag them and nag them.

OTOH, if your friend did not follow the rules for pre-approval or whatever her insurance company requires, she is out of luck. And if they don't cover a certain procedure or treatment, she is out of luck.

wackymother · Jun 2, 2011

Sometimes it's not the insurance company at fault, it's the hospital's billing department. My DD had an outpatient procedure at a hospital a few years back--in-network hospital, in-network surgeon.

She was in the hospital for about seven hours total. We kept getting stray bills from anesthesiologists, consultants, counselors, I don't know what all.

I called the insurance company and they said that with an in-network hospital and an in-network surgeon, that the hospital HAD to consider everything covered by what the insurance company would pay. The hospital and all these hangers-on were not entitled to keep coming back and asking me for more money. It took many, many phone calls, but in the end I did not have to pay anything beyond what insurance had paid.

isisdave · Jun 2, 2011

And don't forget you can appeal a denial. The instructions are on the letter.

MelBay · Jun 2, 2011

I should have mentioned the protest thing as well. I've had many claims denied over the years and honestly, I can't remember ever having to actually pay for one. I can pick apart a summary plan description and a plan document pretty well, which helps me win my case. I'm not pulling anything over on them, I'm just not allowing them to pull anything over on me.

Honestly, I think they try to pull this because most people don't feel confident enough to battle them or won't take the time to write a letter of appeal. In my experience, it's always been worth it.

I'd start scratching my nails on the chalk board....

MRSFUSSY · Jun 3, 2011

read a few

pages of John Grisham's

The Rainmaker............

Probably fiction

Probably very, very true!

LUVourMarriotts · Jun 3, 2011

2 things I can provide are:

1. When I was in grad school and had to visit the ER, my crummy insurance didn't cover any of it. I called the hospital billing dept. and told them that I couldn't afford to pay the bill they sent me and they dropped it from $1200 to $300 in an instant. So they just want something.

2. I have a relative that doesn't have great insurance and has gone to the hospital for outpatient treatment. The bills keep coming and he pays $10 here, $20 there. As long as you pay something towards each bill, they can't send him to collections. At least that's true where he is in NH. After a few months of low payments, they usually call and give a drastically reduced remaining balance for him to pay and be done. Has worked a number of times.

markel · Jun 3, 2011

LUVourMarriotts said:
2 things I can provide are:

1. When I was in grad school and had to visit the ER, my crummy insurance didn't cover any of it. I called the hospital billing dept. and told them that I couldn't afford to pay the bill they sent me and they dropped it from $1200 to $300 in an instant. So they just want something.

2. I have a relative that doesn't have great insurance and has gone to the hospital for outpatient treatment. The bills keep coming and he pays $10 here, $20 there. As long as you pay something towards each bill, they can't send him to collections. At least that's true where he is in NH. After a few months of low payments, they usually call and give a drastically reduced remaining balance for him to pay and be done. Has worked a number of times.

Thanks. That's kinda the answer to my initial question. As long as she pays something, I hope that she will be OK with the hospital and their collection agency if she pays a minimal amount each month.

dougp26364 · Jun 3, 2011

markel said:
Hi,

I have a friend who asked me (for which I do not know the answer) if there is a minimum you are required to pay a hospital bill for which insurance denies?? She is hoping for some advice before calling the billing office for fear that they may "push" her into higher payments then she can't afford. Is there a specific period of time that a balance needs to be paid in?

Thanks, Mark

This article might be a couple of years old but, it has good information in it that I believe is still relevant. Start with fighting the insurance companies decision. It's better if the provider takes on this task and, in reality they probably should be the ones fighting the decision. Failing that, if this is a prerfered provider, they may not be able to balance bill her for uncovered expenses deemed unnecessary by the insurance company. It would also be a good idea to get the prefered provider contract out (her insurance paperwork) and dust it off to see what it says she's obligated to pay.

Here's a link to the article. http://www.businessweek.com/magazine/content/08_36/b4098040915634.htm

Pat H · Jun 5, 2011

A few years ago I had an emergency appendectomy. I had a 20% co-pay at the time. I called the hospital and asked what kind of discounts they offered. They gave me a 40% discount if I paid in full. I put it on a mileage credit card but it was an amount I knew I could pay off right away. All hospitals offer deals because they often get nothing.

chickenfoot · Jun 5, 2011

Be sure to call the insurance compnay to determine exactly why it was denied. Sometimes its as simple as the Insurance Company asked for medical records or an xray and the hospital fails to send it -- so the claim is denied.

Your friend needs to have a clear understanding why it is not covered so that she can perhaps provide necessary information information for payment.

stevedmatt · Jun 5, 2011

markel said:
Thanks. That's kinda the answer to my initial question. As long as she pays something, I hope that she will be OK with the hospital and their collection agency if she pays a minimal amount each month.

I don't know this for a fact, but someone once told me they were paying $1 per month. As long as they paid something on a monthly basis, they could not go to collections.

I personally would make every phone call possible to either get the charge eliminated or reduced before making a payment. And document everything said and everyone you talk to. It may help getting something removed from your credit report later.

Don · Jun 6, 2011

stevedmatt said:
As long as they paid something on a monthly basis, they could not go to collections.

Not true in FL. Also ask for an itemized statement from the hospital.

bogey21 · Jun 6, 2011

I have always found that a face to face meeting is preferable to phone calls, letters, etc. You have the undivided attention of the creditor. In addition it is also harder for them to brush you off.

I'm assuming that the hospital in question is relatively close by.

George

JudyS · Mar 11, 2013

markel said:
Thanks. That's kinda the answer to my initial question. As long as she pays something, I hope that she will be OK with the hospital and their collection agency if she pays a minimal amount each month.

I wouldn't count on that, as the laws on this almost certainly vary from state to state. In my experience, hospitals vary tremendously in how aggressive they are with unpaid bills. Some will work with you; some will sell the debt to a collection agency very quickly, even if the insurer should have paid.

I would not refuse to pay (or pay very little) as a "protest." Agreeing to pay off the bill over time may be interpreted as agreeing to take responsibility for the debt and giving up on getting insurance to pay.

I agree with the advice for your friend to go in person to the hospital. I would check with the insurer to make sure the service is in fact covered. If it is, I would call the hospital, ask again for their help in rebilling the insurance and fixing the problem, and threaten that if they don't fix the problem soon, I will come in person and sit in their office until they do.

JudyS · Mar 11, 2013

dougp26364 said:
This article might be a couple of years old but, it has good information in it that I believe is still relevant. ...

Here's a link to the article. http://www.businessweek.com/magazine/content/08_36/b4098040915634.htm

Thanks for the link. Wow, that's an amazing article:
...As health-care costs continue to soar, millions of confused consumers are paying medical bills they don't actually owe. Typically this occurs when an insurance plan covers less than what a doctor, hospital, or lab service wants to be paid. The health-care provider demands the balance from the patient. Uncertain and fearing the calls of a debt collector, the patient pays up.

Most consumers don't realize it, but this common practice, known as balance billing, often is illegal. When doctors or hospitals think an insurer has reimbursed too little, state and federal laws generally bar the medical providers from pressuring patients to pay the difference. Instead, doctors and hospitals should be wrangling directly with insurers. Economists and patient advocates estimate that consumers pay $1 billion or more a year for which they're not responsible....

DeniseM · Mar 11, 2013

Please note that this thread is from June, 2011. It was brought out of mothballs by a spammer before post #20 - the spam post was deleted.

Timeshare Von · Mar 11, 2013

DeniseM said:
Please note that this thread is from June, 2011. It was brought out of mothballs by a spammer before post #20 - the spam post was deleted.

WHEW . . . I was reading along well into the thread when I realized it was from 2011. I was wondering why it got resurrected.

JudyS · Mar 11, 2013

Oh great, I've done it again -- responded to an old thread. Oh well, at least the article dougp26364 linked to is still worth reading.

Icc5 · Mar 11, 2013

Hospital Administration

bogey21 said:
I have always found that a face to face meeting is preferable to phone calls, letters, etc. You have the undivided attention of the creditor. In addition it is also harder for them to brush you off.

I'm assuming that the hospital in question is relatively close by.

George

She needs to go to the hospital administration. They have people there that are used to dealing with these problems. Find out if mis coded or what.
When my son was born 20+ years ago they didn't want to pay for a baby in distress (breething problem). I wanted to just pay it and then deal with it and they wouldn't let me. After several months going back and forth they finally said it was a coding error and closed the books on it.
Bart

[2011] Hospital Bills/ Insurance denied ??

markel

MelBay

Rose Pink

markel

Rose Pink

markel

Rose Pink

wackymother

TUG Review Crew: Veteran

isisdave

MelBay

MRSFUSSY

LUVourMarriotts

TUG Review Crew: Veteran

markel

dougp26364

TUG Review Crew: Expert

Pat H

chickenfoot

stevedmatt

Don

bogey21

JudyS

JudyS

DeniseM

Timeshare Von

TUG Review Crew: Expert

JudyS

Icc5