staceyobu Posted October 8, 2012 Share Posted October 8, 2012 DS had a newborn hearing screen in the hospital. The people that did it coded it as if he was taken in to an office rather than being screened in the hospital. So, our insurance is wanting us to pay out of pocket. It would be 100% covered if it was done in the hospital (and it was!). The place refuses to recode it. Insurance is refusing to pay it without them resubmitting the paperwork. Everyone (insurance and hearing screen people) is now telling me to just pay it. :glare: There is absolutely no way we are responsible for this. It isn't even iffy if you look at our benefits. Hearing people are now threatening collections (and I honestly think it is already a collector threatening me... but I digress). What the heck do I do? I'm not paying for things because they code it wrong! Quote Link to comment Share on other sites More sharing options...
ThatCyndiGirl Posted October 8, 2012 Share Posted October 8, 2012 I would continue to argue with the people who can change it and I would point out that it is THEIR ERROR that is causing us to be billed incorrectly to the tune of X dollars. I would continue to go over the heads of those telling me NO. If they continued to refuse I would ask how they plan to compensate me for THEIR ERROR. Quote Link to comment Share on other sites More sharing options...
LMA Posted October 8, 2012 Share Posted October 8, 2012 Do you have any papers from the screening, such as results, showing it was taken in the hospital? Did you go through the appeals process or did you just call the company? Set up a formal appeal with the insurance company and get copies of the records from the hospital to send with the appeal. Talk to the head of the hospital about refiling also. They should refile with the correct code. Quote Link to comment Share on other sites More sharing options...
staceyobu Posted October 8, 2012 Author Share Posted October 8, 2012 It is not the hospital billing me. It is a third party. They come in and do the hearing screens for the hospital. So, who should I argue with more... insurance? or hearing people? or both? Quote Link to comment Share on other sites More sharing options...
Annie G Posted October 8, 2012 Share Posted October 8, 2012 Keep complaining, often. Dh had a serious bladder infection that lasted months. Every time the lab tests were submitted, they coded it incorrectly- as if he was sauntering into the ER for lab tests. Weekly for months. And the insurance company denied it. We kept telling him he wasn't entering the hospital for tests, he was going to the lab. Until they changed it, nothing happened. At some point, they got tired of us calling EVERY day and they changed their coding. It was annoying but not as annoying as paying out of pocket. So sorry you're going through this- how frustrating to have to convince someone to change the coding! Quote Link to comment Share on other sites More sharing options...
Lawana Posted October 8, 2012 Share Posted October 8, 2012 I've never heard of someone refusing to recode an error. Have you gone to the top in the third party? Quote Link to comment Share on other sites More sharing options...
LMA Posted October 8, 2012 Share Posted October 8, 2012 It is not the hospital billing me. It is a third party. They come in and do the hearing screens for the hospital. So, who should I argue with more... insurance? or hearing people? or both? Call the highest person you can find for the third party company, the hearing dept., and the hospital, and the insurance company. Set up a formal appeal with the insurance company at the same time. You are entitled to appeal any insurance decision without paying. Collections should not be bothering you. Get all records from the hospital and the company and send them in with your appeal and any letters you write to these companies. Always include these copies even if you have to make hundreds of copies. If you do letters, CC your state attorney general office and the state agencies that oversees insurance and the medical institutions. This has happened to me previously and this is how I took care of the problem. You have to let anyone related to the charge know you are not paying it and someone needs to take care of it. If you get collections letters, make copies of those with all letters. Quote Link to comment Share on other sites More sharing options...
Guest inoubliable Posted October 8, 2012 Share Posted October 8, 2012 I'd definitely continue to pester someone into coding that correctly! Quote Link to comment Share on other sites More sharing options...
staceyobu Posted October 8, 2012 Author Share Posted October 8, 2012 Call the highest person you can find for the third party company, the hearing dept., and the hospital, and the insurance company. Set up a formal appeal with the insurance company at the same time. You are entitled to appeal any insurance decision without paying. Collections should not be bothering you. Insurance called them today to ask them to put the bill on hold while they looked into it (again). He called me back and said they said "no, pay it now". I'm just floored by that response. And floored that they won't just recode it if they want to get paid so badly. And floored that when I have talked to them previously they have told me "a supervisor would call me by 5:00" and no one ever calls... Quote Link to comment Share on other sites More sharing options...
Cera Posted October 8, 2012 Share Posted October 8, 2012 If they are being that ridiculous about it I would use the "L" word (lawyer). Write them a letter stating when and where your baby was seen how they coded it and how they should have coded it and asking them to fix their error. Also note that if they do not code the bill properly to reflect the services you actually received you will not pay and will pursue legal action if they do not stop pushing you. I would put the letter into the envelope with the bill (no check, definitely do not pay it) and mail both back to the third party company signature required. Quote Link to comment Share on other sites More sharing options...
LittleIzumi Posted October 8, 2012 Share Posted October 8, 2012 Insurance called them today to ask them to put the bill on hold while they looked into it (again). He called me back and said they said "no, pay it now". I'm just floored by that response. And floored that they won't just recode it if they want to get paid so badly. And floored that when I have talked to them previously they have told me "a supervisor would call me by 5:00" and no one ever calls... Oooooooh. :glare: No, I'm sorry, I am staying on the line and not leaving until I talk to a supervisor. Now. Have you told them the ONLY way they are getting paid a penny is to recode it properly, collections or not? It is not your bill to pay. Quote Link to comment Share on other sites More sharing options...
LittleIzumi Posted October 8, 2012 Share Posted October 8, 2012 If they are being that ridiculous about it I would use the "L" word (lawyer). Write them a letter stating when and where your baby was seen how they coded it and how they should have coded it and asking them to fix their error. Also note that if they do not code the bill properly to reflect the services you actually received you will not pay and will pursue legal action if they do not stop pushing you. I would put the letter into the envelope with the bill (no check, definitely do not pay it) and mail both back to the third party company signature required. Rather, with a copy of the bill. You don't want to send them the only bill! Quote Link to comment Share on other sites More sharing options...
Shellydon Posted October 8, 2012 Share Posted October 8, 2012 So the people that did the test were not hospital employees? That may be the problem. Quote Link to comment Share on other sites More sharing options...
QueenCat Posted October 8, 2012 Share Posted October 8, 2012 I've never heard of someone refusing to recode an error. Have you gone to the top in the third party? Me either.... when I've had that issue, they've fixed it asap, so they can get their money. Quote Link to comment Share on other sites More sharing options...
LMA Posted October 8, 2012 Share Posted October 8, 2012 Insurance called them today to ask them to put the bill on hold while they looked into it (again). He called me back and said they said "no, pay it now". I'm just floored by that response. And floored that they won't just recode it if they want to get paid so badly. And floored that when I have talked to them previously they have told me "a supervisor would call me by 5:00" and no one ever calls... Because they are contracted with the insurance company, he cannot make you pay the bill. I would explain that to the person who told you to pay the bill. He is violating the process for the claims because his company is contracted with the insurance company. Call back the insurance company and ask what is the next step. The insurance company can ask them to recode. In fact, it is not your place to ask for a new code. The insurance company should take care of it. Because it is a third party in the hospital, call the head of the hospital and explain how you are being treated. They have to take some responsibility because they allow the company into the hospital. I would start proceeding with complaints with the state attorney general office or your state insurance agency and the insurance company. They cannot bully you into paying the bill and that is effectively what he is doing to you. The other thing you can tell the person asking for payment is that you are entitled to appeal the claim and that is what you are going to do. He cannot make you pay it while you appeal it. Quote Link to comment Share on other sites More sharing options...
vonfirmath Posted October 8, 2012 Share Posted October 8, 2012 So the people that did the test were not hospital employees? That may be the problem. Yeah. its pretty annoying and they are not upfront at ALL with what they are doing. At least the ones for me led me to believe it was a matter of state law that they HAD to do this test. And you've just had a baby and want these people to GO AWAY. I ended up paying the bill. I got tired of fighting it. But that doens't help people that come after from getting bit the same way. Quote Link to comment Share on other sites More sharing options...
FaithManor Posted October 8, 2012 Share Posted October 8, 2012 If they are being that ridiculous about it I would use the "L" word (lawyer). Write them a letter stating when and where your baby was seen how they coded it and how they should have coded it and asking them to fix their error. Also note that if they do not code the bill properly to reflect the services you actually received you will not pay and will pursue legal action if they do not stop pushing you. I would put the letter into the envelope with the bill (no check, definitely do not pay it) and mail both back to the third party company signature required. Legal action. You can threaten to get a lawyer and you will most certainly sue for damages if they so much as consider putting anything on your credit record. Usually, registered receipt, certified letters throwing around the words lawsuit, lawyer, damages, along with proof you do not owe, does get a little attention. Make sure it is addressed personally to the highest up the food chain individual you can find. Faith Quote Link to comment Share on other sites More sharing options...
Susan C. Posted October 8, 2012 Share Posted October 8, 2012 It is not the hospital billing me. It is a third party. They come in and do the hearing screens for the hospital. So, who should I argue with more... insurance? or hearing people? or both? This might be the problem, the third party may be out of network. But since you went to the right hospital, it should be corrected by your insurance when you can show you went to an in network hospital. Insurance called them today to ask them to put the bill on hold while they looked into it (again). He called me back and said they said "no, pay it now". I'm just floored by that response. And floored that they won't just recode it if they want to get paid so badly. And floored that when I have talked to them previously they have told me "a supervisor would call me by 5:00" and no one ever calls... Call the patient advocate at the hospital and tell him/her what has happened. It makes the hospital look bad to have their patients treated like this by a service the hospital has picked, this person should help you take care of this. Quote Link to comment Share on other sites More sharing options...
Barb_ Posted October 8, 2012 Share Posted October 8, 2012 Also, get your State Insurance Commissioner involved: http://www.insuranceclaimsconsult.com/Ins.Commissioner.htm Quote Link to comment Share on other sites More sharing options...
TechWife Posted October 8, 2012 Share Posted October 8, 2012 Do you have any papers from the screening, such as results, showing it was taken in the hospital? Did you go through the appeals process or did you just call the company? Set up a formal appeal with the insurance company and get copies of the records from the hospital to send with the appeal. Talk to the head of the hospital about refiling also. They should refile with the correct code. This, exactly. The baby's chart should show that it was an in hospital screen. Appeals really aren't that hard to do, call your insurance company and ask them what the procedure is. Quote Link to comment Share on other sites More sharing options...
T'smom Posted October 8, 2012 Share Posted October 8, 2012 We had a similar problem. We were at a network hospital, using network doctors, but the hearing screen people were third party and out-of-network. We did not have a choice of screeners, the hospital only used the one and we didn't know it wasn't in network. I threw all kinds of fits and submitted an appeal. I totally expected to win the appeal, but I didn't and we paid it. I was furious at the time and now I'm furious all over again. I hope your situation works out better than ours. Quote Link to comment Share on other sites More sharing options...
melissad2 Posted October 8, 2012 Share Posted October 8, 2012 Also, get your State Insurance Commissioner involved: http://www.insuranceclaimsconsult.com/Ins.Commissioner.htm :iagree: Call the hospital anyway and see if they can help. Tell the hearing people you are going to file a complaint with the insurance commissioner and if they want to be paid they WILL recode it properly. Quote Link to comment Share on other sites More sharing options...
MooCow Posted October 8, 2012 Share Posted October 8, 2012 Appeal it. In writing. When I was admitted to a hospital my insurance (Kaiser) didn't take because I was in another state, I had to have emergency surgery. Kaiser fought me. They wanted me to fly back to my home state. Ha! Yea right ....All the darn office managers from the various drs threatened to ruin our credit, said pay it and they'd reimburse me, blah blah blah. I kept excellent records, called once a month (all TWELVE of them), and sent copies of my correspondence with my insurance to all the office managers. Really p***ed them off too. :D Nine months later, I won. Quote Link to comment Share on other sites More sharing options...
staceyobu Posted October 9, 2012 Author Share Posted October 9, 2012 The insurance company has resubmitted it to their appeals process. However, he admitted to me today that they were past their 45 day mark for getting an answer and no answer had come back yet from the appeals process. No one has said anything about it being out of network. They just say it was coded as an in office visit after we were discharged so they are wanting me to pay it as part of the baby's deductible. Since it was done in hospital, it should be covered on my deductible. I swear we will never let them screen another child in the hospital. It would have been cheaper for me to make an appointment with an ENT for a full examination with their audiologist and physician! Quote Link to comment Share on other sites More sharing options...
In The Great White North Posted October 9, 2012 Share Posted October 9, 2012 When did they start screening newborn's hearing anyway? They didn't screen any of mine. Quote Link to comment Share on other sites More sharing options...
staceyobu Posted October 9, 2012 Author Share Posted October 9, 2012 When did they start screening newborn's hearing anyway? They didn't screen any of mine. At least 7 years ago... Quote Link to comment Share on other sites More sharing options...
Jpoy85 Posted October 9, 2012 Share Posted October 9, 2012 When did they start screening newborn's hearing anyway? They didn't screen any of mine. My oldest is 7 and it was done then and with the other 2 children. I would call the Patient Advocate. You COULD also wait til it goes to collections and is on your credit then appeal it. I know thats not what you want but it might be 1000x easier to deal with then only because when you file to have something dropped off your credit, you just send them the proof and thats it. We had an eviction on our credit when the landlord had dismissed the eviction (there are 2 counts with an evict and he thought hed still get the money part). We sent the credit bureau a copy of the court decision and a letter telling them to drop it- we heard back within 30d it was off. Quote Link to comment Share on other sites More sharing options...
kitten18 Posted October 9, 2012 Share Posted October 9, 2012 Because it is a third party in the hospital, call the head of the hospital and explain how you are being treated. They have to take some responsibility because they allow the company into the hospital. :iagree: The hospital should know their provider is treating patients this way. It's hard to believe your account is the only one that is messed up. Quote Link to comment Share on other sites More sharing options...
Paige Posted October 9, 2012 Share Posted October 9, 2012 This is not the insurance company's problem and I know from experience that they will never pay it if it isn't coded correctly. You should tell them that you will never pay it either without proper coding and request that they contact you in writing. If they call after that, do not speak to them other than to reassert that you wish to be contacted in writing only- then hang up. You can also call the phone company and try to block the number. If you go to a restaurant and order and eat a salad would you pay for an entree and dessert because they coded it wrong? It's ridiculous and extortion. Do not pay. You will never get the money back no matter what they say. Quote Link to comment Share on other sites More sharing options...
In the Rain Posted October 9, 2012 Share Posted October 9, 2012 Call the patient advocate at the hospital and tell him/her what has happened. It makes the hospital look bad to have their patients treated like this by a service the hospital has picked, this person should help you take care of this. :iagree: this is what I was thinking too. The hospital may have some leverage with the third party. Quote Link to comment Share on other sites More sharing options...
staceyobu Posted October 9, 2012 Author Share Posted October 9, 2012 :iagree: this is what I was thinking too. The hospital may have some leverage with the third party. I'll try to call them tomorrow. They have been so rude to me on the phone that I would like to complain to everyone in the world! Quote Link to comment Share on other sites More sharing options...
besroma Posted October 9, 2012 Share Posted October 9, 2012 :iagree: The hospital should know their provider is treating patients this way. It's hard to believe your account is the only one that is messed up. :iagree: I hope it is resolved soon! Quote Link to comment Share on other sites More sharing options...
Tammyla Posted October 9, 2012 Share Posted October 9, 2012 :confused:Crazy...I hope it can be resolved soon. Quote Link to comment Share on other sites More sharing options...
mommytobees Posted October 9, 2012 Share Posted October 9, 2012 Insurance called them today to ask them to put the bill on hold while they looked into it (again). He called me back and said they said "no, pay it now". I'm just floored by that response. And floored that they won't just recode it if they want to get paid so badly. And floored that when I have talked to them previously they have told me "a supervisor would call me by 5:00" and no one ever calls... It is not the hospital billing me. It is a third party. They come in and do the hearing screens for the hospital. So, who should I argue with more... insurance? or hearing people? or both? Morning... I know I'm coming into this late, but hopefully in time to help you. Okay, lets make sure I understand what you have here: 1) baby had hearing test done IN THE HOSPITAL 2) The hearing test is NOT done by the hospital but by a third party (not unusual). 3) The third party billed incorrectly and thus the insurance company isn't paying. IF I understand you correctly I'd handle this like this (OH, and I HAVE done this before too). Pre-#1 a) IF the insurance calls again tell them unless they are willing to adjust the billing coding themselves NOT to call you again. b) IF the third-party hearing company OR their collection agent calls say this: --- You / your company created this problem. I will NOT be paying out of pocket for this test. You have two choices. You may either EAT the cost or you may resubmit the bill with the proper coding. DO NOT CALL ME AGAIN. If they do not call you DO NOT call them again. Not until after you do a few things. 1) Call the hospital and/or your insurance. Ask them what the "normal" billing code for hearing should be and what was actually submitted. Depending you your health insurance you might be able to get this from them. I would get all the information from my health insurance company, but my health insurance company can easily be bullied into doing the right thing. 2) Call the state Attorney General's office for your area. Depending on where you live that _might_ be in your state capital OR there might be a local office in the nearest city to where you live. It isn't hard to find. Call them up and ask who you need to discuss medical billing errors MALPRACTICE with in their office. This is a borderline malpractice issue. What happens is this: The billing code is done in "error" because it obtains them more money. The insurance isn't willing to manually adjust or exempt it because it costs them less money (OR) because they aren't "allowed" to make the change. Depending on whom you talk to will give you your next step. You will be told to call them (the hearing agency) back and notify them that you have spoken with a member of the AG's office and blah-blah-blah. They will either tap-dance-fast and fix this "error, so sorry".... or they will blow you off. The AG's office MIGHT be building a case against them already and tell you to wait and they'll call you back. Tell the person they have a week before you will call them back. You need to be kept informed as to how to proceed. 3) Watch your credit history. If this bill comes up on your history, contest it. DO NOT BE SCARED. They will bully and bully you. Call the AG's office again. Notify them of any action against you. Keep ALL of your paperwork and prepare to fight it. 4) Be prepared to be taken to court. IF they feel that they have a leg to stand on, they will sue you. DO NOT BE SCARED. They will bully and bully you. Call the AG's office again. Notify them of any action against you. Keep ALL of your paperwork and prepare to fight it. Now, having read all of this. IF YOU and/ or your husband can't handle all this, then just pay it. Sometimes it isn't worth the fight. Only YOU and DH can make that decision. Kris P.S. I've fought this battle on several occasions. For some reason I have a Great Big Huge Sign on my forehead that says "fool, take advantage of." They were ALL mistaken. I do NOT comply....honestly, I'm too much of a b*t*h to pay when I don't have to pay. Usually the minute you TELL the company billing (the hearing agency in your case) that you are intending to call the AG's office they fix it. But, in your case I wouldn't waste anymore time. They have already told you several times they won't change it and are now bullying you. Stupid people. Quote Link to comment Share on other sites More sharing options...
QuirkyKidAcademy Posted October 9, 2012 Share Posted October 9, 2012 Morning... I know I'm coming into this late, but hopefully in time to help you. Okay, lets make sure I understand what you have here: 1) baby had hearing test done IN THE HOSPITAL 2) The hearing test is NOT done by the hospital but by a third party (not unusual). 3) The third party billed incorrectly and thus the insurance company isn't paying. IF I understand you correctly I'd handle this like this (OH, and I HAVE done this before too). Pre-#1 a) IF the insurance calls again tell them unless they are willing to adjust the billing coding themselves NOT to call you again. b) IF the third-party hearing company OR their collection agent calls say this: --- You / your company created this problem. I will NOT be paying out of pocket for this test. You have two choices. You may either EAT the cost or you may resubmit the bill with the proper coding. DO NOT CALL ME AGAIN. If they do not call you DO NOT call them again. Not until after you do a few things. 1) Call the hospital and/or your insurance. Ask them what the "normal" billing code for hearing should be and what was actually submitted. Depending you your health insurance you might be able to get this from them. I would get all the information from my health insurance company, but my health insurance company can easily be bullied into doing the right thing. 2) Call the state Attorney General's office for your area. Depending on where you live that _might_ be in your state capital OR there might be a local office in the nearest city to where you live. It isn't hard to find. Call them up and ask who you need to discuss medical billing errors MALPRACTICE with in their office. This is a borderline malpractice issue. What happens is this: The billing code is done in "error" because it obtains them more money. The insurance isn't willing to manually adjust or exempt it because it costs them less money (OR) because they aren't "allowed" to make the change. Depending on whom you talk to will give you your next step. You will be told to call them (the hearing agency) back and notify them that you have spoken with a member of the AG's office and blah-blah-blah. They will either tap-dance-fast and fix this "error, so sorry".... or they will blow you off. The AG's office MIGHT be building a case against them already and tell you to wait and they'll call you back. Tell the person they have a week before you will call them back. You need to be kept informed as to how to proceed. 3) Watch your credit history. If this bill comes up on your history, contest it. DO NOT BE SCARED. They will bully and bully you. Call the AG's office again. Notify them of any action against you. Keep ALL of your paperwork and prepare to fight it. 4) Be prepared to be taken to court. IF they feel that they have a leg to stand on, they will sue you. DO NOT BE SCARED. They will bully and bully you. Call the AG's office again. Notify them of any action against you. Keep ALL of your paperwork and prepare to fight it. Now, having read all of this. IF YOU and/ or your husband can't handle all this, then just pay it. Sometimes it isn't worth the fight. Only YOU and DH can make that decision. Kris P.S. I've fought this battle on several occasions. For some reason I have a Great Big Huge Sign on my forehead that says "fool, take advantage of." They were ALL mistaken. I do NOT comply....honestly, I'm too much of a b*t*h to pay when I don't have to pay. Usually the minute you TELL the company billing (the hearing agency in your case) that you are intending to call the AG's office they fix it. But, in your case I wouldn't waste anymore time. They have already told you several times they won't change it and are now bullying you. Stupid people. The bolded is exactly what I thought. They are counting on your paying the higher amount just to get them off your back. Quote Link to comment Share on other sites More sharing options...
Hwin Posted October 9, 2012 Share Posted October 9, 2012 Attorney General, possibly the state insurance department as well, and you should get someone to fix things. Quote Link to comment Share on other sites More sharing options...
Barb_ Posted October 9, 2012 Share Posted October 9, 2012 (edited) Did a quick Google search and came up with this: https://windsorpeak.com/vbulletin/showthread.php?t=204903 http://www.topix.com/forum/business/outsourcing/TJDBNCPK4NBD0BR49 This apparently isn't an unusual problem. It might help. You also may want to check here and find out what your state's law has to say about reimbursement for hearing screens: http://www.infanthearing.org/legislative/provisions/coveredbenefit.html Insurance crap burns me up. Edited October 9, 2012 by Barb F. PA in AZ Quote Link to comment Share on other sites More sharing options...
fhjmom Posted October 10, 2012 Share Posted October 10, 2012 When did they start screening newborn's hearing anyway? They didn't screen any of mine. In Texas, Universal Newborn Hearing Screening was mandated beginning in 2001, but there were still exemptions for rural hospitals and such until this past year, when those exemptions were finally done away with. Quote Link to comment Share on other sites More sharing options...
kroe1 Posted October 10, 2012 Share Posted October 10, 2012 Tell them you are reporting to the state Insurance Department for fraud. Inappropriate billing is fraud. Treble damages can be levied on whomever billed this. Also tell them you are reporting them to the police for kidnapping your child from the hospital and taking her to some office for a hearing test. :grouphug: Quote Link to comment Share on other sites More sharing options...
LizzyBee Posted October 10, 2012 Share Posted October 10, 2012 When did they start screening newborn's hearing anyway? They didn't screen any of mine. I know my 16 yo and 11 yo were screened. I'm not sure about my 18 yo. Quote Link to comment Share on other sites More sharing options...
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