Several weeks ago, I was diagnosed with double pneumonia (medical term would be “bilateral pneumonia”). After a week, I was feeling worse, not better. One night I was feeling light headed, shaky, and needed to hold onto things to get around the house. I woke up my husband and asked him to take me to the ER. We went to a large, nationally renown hospital, and when my blood pressure was noted by the front triage nurse to be 213/99, I was quickly taken back to one of the rooms in the ER. Long story short, my electrolytes were dangerously out of balance, and I was officially admitted for IV re-hydration. The doctors explained that they had to slowly replace the electrolytes-doing it too fast could cause brain swelling or cardiac arrest.
Even though officially “admitted”, I never did get a bed. I was told I would be moved to “room number ___,” but it never happened. The hospital was completely full. Instead, I lay on a stretcher in the ER for 34 hours. I did have a “private ER room,” in contrast to many whom I observed to be on stretchers in the ER hallways. But I never received a hospital bed, didn’t have a bathroom, or any of the other amenities one would find in a private hospital room. Eventually, they sent me home after my electrolytes were brought up to a minimum standard.
A couple of days ago, I received the bill, with a $1400 charge for a “private room.” I called the number for billing questions, explained the situation, and the woman who took my call said “Well, I really don’t know what you are asking for here.” I said “I never got a private room. I had to lie on an uncomfortable stretcher in the ER for the entire time. I had no hospital bed, no bathroom, no window, nothing. In other words, no private room.” She sighed as though annoyed and said she would mark it as “Disputed” and would “send it on to the appropriate department.”
My question is what to do if they deny my dispute of the charge. Is there an additional process here? Should I pay the rest of my bill and simply substract the disputed amount so that the remainder does not appear delinquent? It’s due in a few days.
You should tell your insurance company because the hospital coded things wrong. Either by accident or purposely. Your insurer can be a powerful advocate for you.
The same thing happened to my DH in January. Had it only been an ER visit, we would have had a $90 copay. Because he was officially admitted (but never got a room), we had a $490 copay. I didn’t even think to dispute it; I just paid it. Keep us posted!!
So I called Blue Cross Blue Shield. She said she could call billing and the three of us could discuss, but the billing dept lady said she had no authority to make changes, so that seems a waste of time at present. I guess I’ll wait to see what the Dispute Dept has to say about it, and maybe regroup with my insurer later. I can’t say I’m impressed with the “help” I received at either entity.
I’m assuming you have health insurance through your employer? Ask your HR department if they have an insurance rep that can help with resolutions. We do, and it helps tremendously not to have to go through the 1-800 number and get someone with no authority to do anything.
I’ve done the “dispute” thing with various bills through doctors (once it was a hospital, but just lab/doctor visit work, nothing major), and they get nowhere. I think they send it through the same channel and it’s processed exactly the same. After a few times of that, I started using our rep and she has much better outcomes!
Unfortunately, I get my health insurance through DH, who is self employed. No HR dept. to go through.
I’ve never disputed anything ever. It doesn’t come naturally to me, though I know we have some dispute veterans here on CC who will go to the mats over a few dollars! That’s why I thought of coming here for advice first, lol. My DH is a champion of negotiations and just went through five rounds of disputes with a collision repair service that wrecked our brand new car right after they had fixed a very minor scratch, but since this one was on my account, I figured I’d at least go through the early stages myself.
I had a dispute with a doctor who kept on submitting to the insurance company with the wrong code. Even after calling the insurance company and giving the doctor’s billing office instructions on exactly what they needed to submit. The insurance company can not recode the bill, the doctor or hospital must redo it. I would see what the hospital says after they review the dispute.
Well boo. It was worth a shot. What I’ve had to call about wasn’t a dispute in the service, it was that the doctor’s billing didn’t match the EOB. The insurance company said the doctor was in-network and they had a contract for a service to cost me X instead of Y. And the doctor’s bill will say, yes, it’s in network and the insurance company says that I owe X, and then still say I’m still responsible for Y.
Makes no sense, and yet I’ve had several doctors’ offices and 1 hospital do this. And I’ve done the calling both sides and they put it in the disputed/escalate the problem thing over and over, and nothing ever changes…
I’d probably call the insurance company and ask to speak with someone above the initial person.
We have contacted a hospital billing department because our invoice included medicine that was never provided and tests that were never performed. It took some back and forth, but they did remove the items from the bill. Maybe we had more luck than others here because the items were relatively low cost.
As with grocery stores where the price for items at the register and shelves differ, but invariably are higher at checkout, the discrepencies on your hospital invoice were not an honest mistake. (Has anyone here ever received a hospital bill where a mistake was made in the patient’s favor?) Hospitals add insult to injury by making the process of challenging a bill a bureaucratic nightmare.
As others have noted, you can reach out to your insurance carrier for help. Some states have consumer protection offices that might get the hospital administration’s attention. There are also services that will review medical bills, line-by-line, and challenge excessive charges. I think they work on a contingency basis and keep some percentage of the savings they negotiate for you. Unfortunately, I think they focus on larger bills after a surgery or extended hospital stay, and may not want to deal with a $1,400 charge.
If you are having trouble “penetrating the bureaucracy” (name that movie), LinkedIn is your friend. Several times when I was getting the run-around by companies after they didn’t honor their obligations I was able to find the manager who was ultimately responsible for that region or function on LinkedIn and contact them directly, bypassing layers of bureaucracy and gatekeepers. I have done this three times, and every time the manager I contacted resolved my issue.
I’ve disputed a few. And came out on the winning end.
DD was admitted to the hospital 26 hours after an ER visit when the ER doc sent her home with an appointment to see a GI doc. WhenDD got to the GI doc, that doc said they should never have let her leave the ED. Within 24 hours, there was no copay for the ED visit…but after that it was a $50 copay. I called my insurance, and explained…and never heard from the hospital again. Got a new EOB with NO charge.
DH was in a serious bicycle accident. He was flown via LifeStar to the nearest Level 1 trauma center. Our insurance clearly stated that this was a covered in total cost, and paid the bill. About 2 years later, I got a bill from LifeStar for the total cost. I contacted my insurance, and they said they would take care of it. I never got another bill…and I already HAD the EOB that said my insurance fully covered the cost.
I had C sections with both of my kids. The second time, the billing was submitted for a vaginal delivery which is far less costly. The billing folks said I owed the difference. I told them to resubmit. They said they couldn’t do so unless I could prove I had a C-section. So…I drove to their office and showed them my scar (which was mostly healed but fresh enough that it was clear). Oh…they also billed me separately for a surgical tubal ligation even though I was already open from stem to stern. I disputed that too. It was all covered.
I really admire you Dispute the Bill warriors. I think entities count on people like me, who really don’t like to do this, to ultimately give up, in order to balance out the ones who will fight for what’s right.
I fought a physicians bill claiming to have treated a parent AFTER the patient was dead. I got every ridiculous excuse under the sun but eventually I got it settled. So aggravating. Most heirs give up I presume…how much paperwork can you deal with at a trying time? But I was determined to send a message to the “corporate owners” of the practice who will over treat and overcharge assuming people won’t take it on …
It’s kind of the same thing I’ve been dealing with chasing earned benefits for my Vietnam Vet father for Agent Orange health consequences. Congress made a law giving Vets access to these benefits. But SOMEONE in charge of handling this makes it extremely hard and burdensome to actually get these benefits, so that people like my Dad, whose good health was RUINED, give up in frustration. It’s disgusting.
So to the point of getting insurance involved: The insurance already designated what they will pay and have done so. This charge is on me. Why would insurance expend time and energy on this?
I’ve never really ever had a charge that stuck out as just wrong before. So this is new territory for me.
When I was dealing with trying to get my Vietnam Vet Dad his earned benefit from Agent Orange exposure, I had been dealing with it for almost 18 months. On a phone call with the VA, I was told he needed to present himself to the Va in person for the final whatever the latest hoop we needeed to jump thru. I called the number and told them my Dad, THANKS TO AGENT ORANGE, could NOT travel. He is so disabled that getting him to a remote office is impossible. The lady and I went back and forth about how my Dad could NOT come in person for a meeting that could easily be done via zoom. The woman would not budge, stating “He HAS to come to our office.” I said “what if he were in a coma as a result of his health issues, what then?” She said “you would need to bring him here to the office for the in-person meeting.” When you’re dealing with this kind of insanity, it becomes clear that they don’t give a flying flip for our veterans, who have given/risked their lives for our benefit. They really just DO NOT CARE.
