problem with insurance company, I need advices

Parent Cafe
1

<p>I went to an emergency room at a hospital. The bill was X amount. I have insurance. The insurance company said they paid the bill</p>

<p>It’s turned out the insurance company paid my bill, but because the hospital has owned the insurance company some money. So the insurance company “deducted” the money from “my bill” … or whatsoever … that I have nothing to do with …</p>

<p>The hospital has kept sending me the bill , and I’ve kept calling the insurance company in the last 6 months. </p>

<p>The insurance company said it’s not my problem. It’s the hospital problem.</p>

<p>Now the hospital has turned the bill to a collection agency. The collection company just called me today </p>

<p>Any body knows a best way to handle this problem ?</p>

<p>Thank in advance</p>

2

<p>Tell the collection company that your insurance company is dealing with this and that they have told you not to pay anything more to the hospital. Make them put a note in your file. Tell the collections agency that you do NOT want anything reported to the credit bureau and that if they do report anything you will dispute it. Tell them not to call you and to stop collections on the bill. It is a problem between your insurance company and the hospital. </p>

<p>Then call the insurance company and tell them the same thing. Make them put a note in your file.</p>

3

<p>That sounds REALLY bizarre… you might consider checking with your state’s Department of Insurance, to see if this was handled properly. Doesn’t sound like it.</p>

4

<p>It depends on what state you are in, but at a minimum you should contact your State’s bureau of insurance that regulates insurance companies. Your state also probably has a government entity regulating hospitals, but usually those bodies are ineffective. Also, you can contact a lawyer.</p>

5

<p>If I follow you correctly, the insu co. was trying to collect back some $$ that perhaps they erroneously paid, or overpaid, on another patient, and deducted it from the payment made on your account. Do ou have a copy of the explanation of benefits (EOB)? Does it show how much was approved to be paid for your services? Did you ever speak to anyone in the billing department at the hospital when they sent you the erroneous bills? If not, that is who you need to call (though if they already turned it over to the collections agency they may tell you that they are a little limited in what they can do). If you never brought the error to the billing dept at the hospital, their claims/accounts clerks didnt know you were being incorrectly billed, and the computer kept generating bills. Your lack of response is what sent it to collections. Deal withteh hospital, not your insurance company. Good luck.</p>

6

<p>your bill. Go get some of the insurance company’s literature. When they say the will pay a certain percentage of the charges after the deductible, they are obligated to pay that percentage. They cannot deduct charges that the hospital owes to them on your bill. </p>

<p>Go back to the insurance company and get them repeat what they said to you. Get a witness and be sure that you tell the insurance company that you have some with you to help you understand their practice. Perhaps you can go the hospital and make that same phone call with the hospital billing office listening with you so that all three parties can figure this out. </p>

<p>You got a problem either you misunderstand the terms or the insurance company is pulling a number on you.</p>

7

<p>“It’s turned out the insurance company paid my bill, but because the hospital has owned the insurance company some money. So the insurance company “deducted” the money from “my bill” … or whatsoever … that I have nothing to do with …”</p>

<p>Where did you hear this from? The hospital or the insurance carrier?</p>

<p>"The hospital has kept sending me the bill , and I’ve kept calling the insurance company in the last 6 months. "</p>

<p>Who is the carrier?</p>

<p>“The insurance company said it’s not my problem. It’s the hospital problem.”</p>

<p>very well could be. </p>

<p>"Now the hospital has turned the bill to a collection agency. The collection company just called me today "</p>

<p>Do you have an eob from the insurance carrier? Start there. If you have documented proof of payment on your behalf, that the insurer paid it’s portion of the claim.</p>

<p>A question comes to mind, did you pay your part? Could you be going to collection because you owe money for your portion? or have you paid it? </p>

<p>“Any body knows a best way to handle this problem ?”</p>

<p>Need to know what state and who the carrier is, otherwise who knows. How did you purchase this coverage and how long have you owned it? </p>

<p>I have never ever heard of tit for tat between a hospital and insurance carrier over excess monies and using a patient billing to resolve it in my 20 years doing this… something’s odd about the story and unless a little more detail is given, really can’t provide help.</p>

8

<p>Thank you everyone.
jym626, I did call the hospital. They said they haved not been paid by the insurance so they wanted me to pay the bill. It’s the insurance company who explained the problem to me. On the statement I received from the insurance company it said I have to pay zero amount to the hospital.</p>

9

<p>opie-
While fortunately this hasn’t happened to me, I have heard of colleagues who have had payments for patient “A” reduced because of an overpayment or expected refund on patient “B” . For example, The insu co does an audit and sees that they paid a claim incorrectly (overpaid) or maybe a pts policy terminated and they shouldnt have paid the claim at all. So they contact the hospital and ask for a refund. If the hospital doesnt pay, the insu. co says they will withold the payment from another patients payment. It isn’t that unusual. Medicare does it. So do some of the other carriers (cant recall who off the top of my head). So, the call needs to go to the hospital. As you said, there might be a copay owed too, but this sounds like the insu co witholding payment because of a disputed amount on another patient.</p>

10

<p>"I have heard of colleagues who have had payments for patient “A” reduced because of an overpayment or expected refund on patient “B” .“but this sounds like the insu co witholding payment because of a disputed amount on another patient”</p>

<p>Yes, I understand what you’re saying, but they don’t share that type of information with an insured. That doesn’t happen. A provider may get an accounting adjustment based on a list of patients, but those patients are never told if the doctor is plus/minus accounting wise by a carrier… no? That’s not something an insurer would share with an insured. </p>

<p>That is why I was asking about where that information was coming from. I could see it coming from the accounting office at the hospital, but not from a claims rep as they wouldn’t have access to that kind of detail. </p>

<p>I once recieved the follow up billing from a local hospital for my D’s birth on her second birthday… along with a threat of collection if I didn’t pay right away. Well that was two insurance carriers ago as well. So doing a little footwork, I found the hospital had one person doing accounts receivable for a busy 1400 bed hospital with a large emergency room. One person… </p>

<p>What I found out from her replacement was everday the old accts billable person would sweep all the unmailed billings off her desk next to the wall in the crack between the desk and wall. When she finally quit (overworked) and they moved her desk they found several hundred thousand in unmailed and unentered billings. They weren’t even in the system. So they went about remailing them with collection notices as quietly as possible. </p>

<p>In my case it was around $1500 in unpaid claims. Had they been billed within a year they would have been paid at 100%, but now the insurance carrier had no obligation to pay this claim as they did pay everything as presented. So the hospital said the bill was mine… I offerred my daughter as since she was in her terrible twos, they could have her back… </p>

<p>They balked at that idea. I then suggested since in reality it was their problem staffing wise that they show some good will and eat this billing. After all, the newspapers love stuff like this… this was a conversation I had with the hospital administrator, she agreed, it was not my problem, done. If this story shapes up along the same lines, it might be handled the same way. It is not the patient’s problem, it is between the hospital and provider. </p>

<p>I think before we can really answer this person’s question and provide help, we need to know more. Where this information came from, why the poster waited six months, who the insurer is and what state. I need to know the state because every state has different insurance rules and advising without knowing might not be helpful.</p>

11

<p>I had the same situation. I spoke to about five different people from the insurance, documented their names and dates, sent a letter, got nowhere. Finally the billing department of the doctor’s office (bill was for therapy visits) figured it out, and intervened for us.</p>

<p>Your insurance wouldn’t be through the federal government, would it?</p>