Ask Me Help Desk - Hip replacement bill

Hello

Last year I had a full hip replacement, the total bill was close to $50.000. My insurance policy said that my insurance would paid 100% after I meet a $750.00 deductible. Which I did without a problem.
Now over a year later I get a bill from the hospital charging me for $3.000 that the insurance company denied. I called the insurance company and they said that there is a contract issue between them and the hospital, and they feel the hospital is charging them for the same items twice. Then I called the hospital and they said that since the insurance refused to pay it is my responsibility. Wait a minute if there is a contract issue between the two organizations, what do I have to do it? I told them to try to work things out between them and both managers one from the hospital and another one from the insurance co. said that they were done talking to each other!! I ask them if they were children, because they were sure acting like one.
Anyhow now I am stuck with this bill, I filled a complaint with Batter Business Bureau. But haven't heard from them yet.
Can someone tell me what to do? Am I really responsible for this bill? And if not how can I handle this situation?

Thank you

Marcia

Is your insurance through your employer? If so, then you should have your employer deal with it. If not, then go to the State Insurance dept. You are not responsible.

Quote:

Originally Posted by marshodge

Hello

Last year I had a full hip replacement, the total bill was close to $50.000. My insurance police said that my insurance would paid 100% after I meet a $750.00 deductible. Which I did without a problem.
Now over a year later I get a bill from the hospital charging me for $3.000 that the insurance company denied. I called the insurance company and they said that there is a contract issue between them and the hospital, and they feel the hospital is charging them for the same items twice. Then I called the hospital and they said that since the insurance refused to pay it is my responsibility. Wait a minute if there is a contract issue between the two organizations, what do I have to do it? I told them to try to work things out between them and both managers one from the hospital and another one from the insurance co. said that they werw done talking to each other!!! I ask them if they were children, because they were sure acting like one.
Anyhow now I am stuck with this bill, I filled a complaint with Batter Business Bureau. but haven't heard from them yet.
Can someone tell me what to do? Am I really responsible for this bill? And if not how can I handle this situation?

Thank you

Marcia

It was tru my old employer in Ohio we relocated to NE due to my hunband's job.

Where did you have the surgery? Ohio or NE?

Then I would contact the Ohio Insurance or health care oversight depts.

I will jump in and disagree, You signed, if you read the hospital info carefully, that you would be responsible if the insurance did not pay.

Your insurance policy says it will pay ( and I am assuming) all resonable and customary charges. And some insurance companies have contracts with the hospital and doctors, if if they don't, there are normally non covered items.

You can get from the insurance company a list of those items they will not pay for. ** and it is very common for hospitals on large bills to bill incorrectly or twice for things. ( there is even an industry that just looks for these savings)

So if they don't pay the hospital will hold you liable and it will go against your credit report. You have a right to seek mediatio with the insurance company or sue them if they do't pay.

But if there are over charges or double billing, the insurance company will not pay those,

Well so if the insurance company fells they are being charged for the same items twice, I am no going to pay for samething that was already paid for either! Correct?

If that is the case yes, you will need a complete itemized bill from the hospital, and you will need the insurance company to give you exactly which items were billed twice.

** this is not uncommom at all, the few times I or my wife have been in the hosptial, I have found "non recieved services" or "double billing" on every bill.

But also a lot of issues is if all the doctors that treat you have to part of the plan that accepts that insurance company, I will give you an example from my local hospital, The hospital accepts the isurnace contract as listed, but guess what the ER doctors don't, nor does the lab, so there is always bills not paid, even if the insurance says it pays 100 percent,

That is only 100 percent of their reasonable and customary charge, and if the doctor does not accept this as full payment, then the doctor bills you for more, if the doctor has a contract with the insurance company where they have to accept it, great, if not, there is always more owed.

For example, for ER my insurance pays 100 percet after a deductable is paid, well in my case this year, the hosptial accepted their payment as paymet in full, but the ER doctors are not hospital employees, but contract workers though a ER doctor company. They do not accept contracts with insurance companies, so they said the insurance companys payment was not enough, but that is all they insurance will pay, so another 1000 or so was due,

Did you have a PPO or HMO? Was the hospital in the carriers network? If the hospital is in the network the contract is to accept payment in full. You pay any deductibles or co pays. Do ask for an itemized bill from the hospital and a copy of what your carrier paid out as a start.

As for some departments not accepting your insurance, B.S. You had insurance that the hospital accepts, IT IS THEIR OBLIGATION TO MAKE SURE ANY AND ALL ASSOIATED DEPARTMENTS WILL ACCEPT IT ALSO.
You have no choice or responsibility to check with each service provided to you while you are a captive patient in their building.
I had an experience where my son was hospitalized. I had an HMO and everything was covered. After discharge the Radiology dept ( a separate practice that paid rent to the hospital ) sent a bill saying they do not accept "my" insurance. I called the hospital President's office and told them it is unacceptable, I had no option to take the X rays to some one else to have read. They agreed and sent me a letter Paid in Full. So there are options.

Quote:

Originally Posted by marshodge

Hello

Last year I had a full hip replacement, the total bill was close to $50.000. My insurance policy said that my insurance would paid 100% after I meet a $750.00 deductible. Which I did without a problem.
Now over a year later I get a bill from the hospital charging me for $3.000 that the insurance company denied. I called the insurance company and they said that there is a contract issue between them and the hospital, and they feel the hospital is charging them for the same items twice. Then I called the hospital and they said that since the insurance refused to pay it is my responsibility. Wait a minute if there is a contract issue between the two organizations, what do I have to do it? I told them to try to work things out between them and both managers one from the hospital and another one from the insurance co. said that they were done talking to each other!!! I ask them if they were children, because they were sure acting like one.
Anyhow now I am stuck with this bill, I filled a complaint with Batter Business Bureau. but haven't heard from them yet.
Can someone tell me what to do? Am I really responsible for this bill? And if not how can I handle this situation?

Thank you

Marcia

Marcia,
Do you have your explanation of benefits from your insurance company? If not, try to get a duplicate. When you look at the eob, check to see with what denial code the insurance used for the charges they did not pay. Did they show this a contractual obligation or patient responsibility? If it is shown as contractual, you would not be responsible. If the eob shows that you are not responsible, I would ask to speak with the manager of the billing department at the hospital. If you get no satisfaction there, keep going up the chain of command until it's resolved. Also, when a provider contracts with an insurance company, there is a provider rep that serves as a liaison between the two. You might also ask who that is and call that person.
Do not give up and pay this! You have to be persistent. Be sure to document each time you make or receive a call about this and the name of the person you speak with. Good luck!
Barbara