Hospital Bill

[GregG]

What is the name of your state? Wisconsin

Hello... I have an outstanding Hospital Bill for services from the last quarter of 2003 till about the first quarter 2004. Somehow insurance didn't cover a good portain of the charges and suddenly I get a Christmas Card from the hospital saying I owe them about a grand.

Anyway... I've been calling the hospital and requesting an itemized statement for the past month. I probably called at least a dozen times.. At one point I even demanded them to overnight an itemized statement or fax it. I still had no luck. The hospital expects me to make a payment at least by the end of the year (3 or 4 days) or they are going to turn it over to collection.

The problem is I never received an itemized statement showing what the charges are for. I would like to cross reference with insurance and investigate why insurance refused to cover the charges.

I have a GENERAL idea what the charges are for, but have not received a breakdown of the charges. In all honesty, I really would like to know what I am paying for before I send them money. I would think it would be my right to know..

I just spent years trying to clean up my credit report. I really would rather not have something show up to haunt me for the next 7 to 10 years..

I think it is plain silly for any firm to send something to collection without informing the customer or client why they are being charged..

My intentions are to pay this bill in a timely manner. I think it is my right to know what charges are for. Do I have any legal options to explore should this bill go into collection?

 

[shell007]

Creditors do not just up and send you to collections for no reason. You had a bill, you've been notified previously (although you deny it), you did not respond with payment, NOW YOU MUST PAY OR GO TO COLLECTIONS.

If you must investigate, and the hospital will not give you the information...call your health insurance provider! They will be able to tell you what the charges are and why!!!

 

[GregG]

Response

True.. I did receive a bill in April of 2004. The bill stated I owed a deductable of $161.00. I paid the deductable and thought everything was taken care of.
November of this year I get note that I am past due for the other amounts insurance didn't cover. HOWEVER, the amount the insurance company will not cover and the hospital is charging me seems to be a different figure. I am not disputing the entire bill. I feel I OWE something and I intend to pay something. But the figures somehow seem to not add up..

I feel I have the right to see an itemized statement and perhaps some of my medical records submitted to insurance. Not sure why the hospital would withhold information from from me. (intentional or unintentional).

If I have a client that requests an itemized statement I feel I am obligated to send them a statement no questions asked. If a client requests 50 copies, I will send them 50 copies. Part of business isn't it?

As far as sending something to collection with no notification.. Yes it happens. I really doubt creditors are out to get you. If something is sent to collection the creditor automatically takes a loss. With understaffing, 3rd party billers, and outsourcing mistakes happen.

If I remember the law correctly medical bills are due upon reciept. They should be paid in full the day the bill is received.. Oh the joy of dealing with insurance companies.. haha..

 

[joybelle5445]

I wonder....

Alabama

I wonder if you sent the hospital a certified letter saying that you are prepared to pay your debt; however, you will require an itemized statement for your files. Also, contact them by phone, inform them of the same, just to cover yourself in the event that it does get nasty. Create a log of your efforts on the matter. I don't know if it would help, but it certainly can't hurt. Good Luck, hope it works out in your favor.

 

[GregG]

Reply

Never really sent a certified letter as of yet.. but I did call them about 20 times during the month of December.. I never called the 800 number. I called the long distance number so the number is at least logged on my phone bill.

 

[Ladynred]

Is there some particular reason you can't GO to the hospital billing office and talk to someone there face to face ?? WHY does everyone assume they can get the job done with useless phone calls ?? Letters at least give you a paper trail, but parking your butt in someone's office makes you much harder to ignore and brush off.

Yes, you ARE entitled to an itemized statement, some hospitals are reluctant to give them to you but you are within your rights to get one. What about the EOB's (explanation of benefits) you got from your insurance company after you received treatment ? Those should completely explain what was and was not covered and why. I would agree that you should contact the insurance company as well. If you didn't keep copies of the EOBs, then ask for copies and keep them.

Medical providers typically will not keep unpaid accounts for more than 90 days, then they send them out to collection agencies, its a pretty standard time frame. Payment is due when services are rendered. Providers file insurance claims for us AS A CONVENIENCE, the patient is still responsible for the bill - and for following up when something isn't paid by insurance.

 

[justalayman]

Payment is due when services are rendered. Providers file insurance claims for us AS A CONVENIENCE, the patient is still responsible for the bill - and for following up when something isn't paid by insurance

Ladynred, you should know better than this. A blanket statement always (get it, a blanket statement ) gets you into trouble.

Actually this is not always true. As long as I go to an "in network" provider, they are contractually obligated to NOT bill me until the insuarance company completes an EOB. It is also not as a conveniance to file. Here, IF they are an "in network" provider they, again, are contractually obligated to file with the insurance co.

 

[Ladynred]

Then explain the 'payment is due when services are rendered' sign in EVERY single medical provider's office I've EVER been in. I work for a large hospital and physican practice management company. Contractual obligation or not, it is still the PATIENT'S RESPONSIBLITY to make sure that bill is paid. You cannot just rest on your laurels and ASSUME that 'everything is taken care of' - it often is NOT.

For anyone availing themselves of any medical services, if you do not keep records of the services you got (the form you get at the office/facility) AND then match that with the EOB from your insurance company - if you have one - then you are not helping your own situation, not to mention that failing to keep records is just plain irresponsible.

 

[weenor]

Having been a similar situation in Wisconsin several years ago, I will add a few things.

First, if you are not getting responses from the hosptial by phone, go there yourself. Often these hospitals outsource bills and not generate them in the location that you are calling. I know years ago, Milwaukee County did not generate the bills in house, so it would take months to get copies. Once we went to the hospital billing office, they were able to tell me where to go to get the bills.

Second, when you get the bill check it closely to see when the charges were submitted to the insurance company and get information from the insurance company to find out when they show that the bills were submitted. Often caregivers do not submit the bills to insurance in a timely manner. The claim is denied and the hospital bills you. If the hospital did not submit in a timely manner that is not your problem and you can contest the portion of the bill owed by insurance.

Third, timely payments or not, hospitals often sell accounts to collection agencies. I made payments to Froedert in a timely manner and they sent my account to collection because they were tired of dealing with it.(they told me that) The problem is that once the collection agency got the account, they had the right to request payment of the full balance without agreeing to the payment terms I had with the hospital. Just food for thought.

 

[justalayman]

Then explain the 'payment is due when services are rendered' sign in EVERY single medical provider's office I've EVER been in. I work for a large hospital and physican practice management company. Contractual obligation or not, it is still the PATIENT'S RESPONSIBLITY to make sure that bill is paid. You cannot just rest on your laurels and ASSUME that 'everything is taken care of' - it often is NOT.

For anyone availing themselves of any medical services, if you do not keep records of the services you got (the form you get at the office/facility) AND then match that with the EOB from your insurance company - if you have one - then you are not helping your own situation, not to mention that failing to keep records is just plain irresponsible.

That sign would apply to everyone except me. Just kiddin'. That is posted for all those who do not have the luxury of having insurance that has contracts in place requiring the actions I stated earlier.

Yes I agree it IS the patient,s responsibility, as you stated. The contracts just help make it easier for me. Correct, you cannot assume anything as stated.

As far as the records go. I do not recieve any bill that would even come close to being considered itemized. They are fairly general. I do not get any billing info upon discharge due to the insurance situation either.

So for the OP, I suspect you have a similar insurance situation. Get copies of the EOB's from the insurance co. Ask them why things were not paid by them. Sometimes it is a mistake somewhere, sometimes merely the way it is supposed to be. If you reach a point where you dispute the charge in general, then ask the hospital for itemization regarding that. Your beef is actually with the ins co more than it is with the hospital. The hospital only wants what is due them.

 

[CarrieT]

Yes, you ARE entitled to an itemized statement, some hospitals are reluctant to give them to you but you are within your rights to get one. What about the EOB's (explanation of benefits) you got from your insurance company after you received treatment ? Those should completely explain what was and was not covered and why. I would agree that you should contact the insurance company as well. If you didn't keep copies of the EOBs, then ask for copies and keep them.
.

You can also ask the insurance company for a copy of the charges that were submitted. Always double check that the charges match what was done or what the ailment was. I know that more times than we'd like to imagine, the charges sent to the insurance company are miscoded... for instance (very loose for instance) you go in for a sore throat, which turns out to be tonsillicitis... the CODE sent to the insurance company is for 'generic sore throat' - which is NOT covered at the same rate as 'tonsillitis'.
OR... the doctors writing is illegible so the coder has to try and 'guess' what the ailment is, from the written description of services. (I used to do inpatient/outpatient and WC billing for a very large hospital and you would not believe the sloppy practices I saw!!)
Ladyinred (and others) are correct... you are BEST served to WALK into the billing office and ask to speak to someone as they can look up exactly what went on with YOUR case right there. If the actual billing information isnt there, they can look up where it is and send you in the right direction.
Carrie.

 

[GregG]

Thanks

Thanks all for the information. I can get copies of the EOB off the internet that's not too much of a problem.. The EOB says the treatments were experimental so not covered.. I did check into this late in 2003 prior to my treatment.The person said Insurance will cover 80% of the treatments. Problem is nothing is documented.. I called them checked into the treatment.. they said it was covered.. So end of story..

I assume the hospital checked into this as well.. When I received a statement around March of 2004.. the hospital statement had 80% of the bill already blocked out for Insurance.. I think the hospital must have checked with insurance otherwise the 80% would not be blocked off.I think I may have a case to dispute with insurance.. but I need to look and see what records were submitted to insurance.. I will probably need to make payments while I dispute.. Until I receive an itemized statement. I am not going to send any payments.

I wonder if it was possible the insurance company may have covered 80% of the treatments in 2003.. but when 2004 rolled around changed their policy and deemed my treatments experimental?


As far as going to the hospital.. I live 40 miles from the hospital and work during the day..My company policy doesn't allow personal days off or vacation during the holiday season (Thanksgiving till New Years Day).. Anyway.. I had a few hours and went to the billing office on Friday.. They were closed.. The hours posted were saturday 9AM till 1PM.. Since I had to go grocery shopping, I stopped there on Saturday..THEY WERE CLOSED.. I had off on Monday. and they were closed.. 4 days off during New Years? Must be nice.. I only got yesterday (monday) off.

Since the holidays are over. I now have Monday's off.. I probably can make a visit on a monday.. The question is do I need to bring my shot gun and demand one at gunpont???? (joking of course)... Or do I tell them I am sitting my butt down in this chair and not getting up until I receive one..

 

[CarrieT]

Thanks all for the information. I can get copies of the EOB off the internet that's not too much of a problem.. The EOB says the treatments were experimental so not covered.. I did check into this late in 2003 prior to my treatment.The person said Insurance will cover 80% of the treatments. Problem is nothing is documented.. I called them checked into the treatment.. they said it was covered.. So end of story..

I assume the hospital checked into this as well.. When I received a statement around March of 2004.. the hospital statement had 80% of the bill already blocked out for Insurance.. I think the hospital must have checked with insurance otherwise the 80% would not be blocked off.I think I may have a case to dispute with insurance.. but I need to look and see what records were submitted to insurance.. I will probably need to make payments while I dispute.. Until I receive an itemized statement. I am not going to send any payments.

I wonder if it was possible the insurance company may have covered 80% of the treatments in 2003.. but when 2004 rolled around changed their policy and deemed my treatments experimental?


As far as going to the hospital.. I live 40 miles from the hospital and work during the day..My company policy doesn't allow personal days off or vacation during the holiday season (Thanksgiving till New Years Day).. Anyway.. I had a few hours and went to the billing office on Friday.. They were closed.. The hours posted were saturday 9AM till 1PM.. Since I had to go grocery shopping, I stopped there on Saturday..THEY WERE CLOSED.. I had off on Monday. and they were closed.. 4 days off during New Years? Must be nice.. I only got yesterday (monday) off.

Since the holidays are over. I now have Monday's off.. I probably can make a visit on a monday.. The question is do I need to bring my shot gun and demand one at gunpont???? (joking of course)... Or do I tell them I am sitting my butt down in this chair and not getting up until I receive one..

I would imagine that the hospital did check what your benefit coverage was at the time, loosely. However you will need to ask them if they have a preauthorization for treatment - particularly if it was experimental and there was some question as to coverage for that. IF the insurance company preauthorized treatment, then they MUST cover it. The preauthorization will also have the percentage amount covered.

I wouldnt go in guns a'blazin... that rarely gets results. I would politely explain the situation and ask them nicely if they could possibly help you in any way. The first place to start is with the insurance biller as she/he has numbers and contacts at her disposal that the others wouldnt have.
Best of luck
Carrie

 

[GregG]

Thanks

Thanks again.. I will probably stop there on Monday.. Never really had something happen like this with this amount of money.

Mostly confused what happened with hospital and insurance billing. I remember my first appointment with this doctor telling me he NEVER had a problem with insurance not covering treatments. I said in a joking manner "your about to have the first".. Maybe I Jinxed it..