Just need to vent about failure to file...insurance (JAWM)

[LisaKinVA]

So, the hospital here has screwed up our insurance filing multiple times.  We aren't talking about minor screw ups, either.

 

Procedures/Appointments that are mine (and can *only* be mine, for obvious, anatomical reasons), are submitted as my HUSBAND's, and are rejected (this is from last spring).  So, dh tells them the problem and they re-submit it a second time....as a procedure for my dh!

 

Other procedures he's never had ($1,000 injections for Thyroid cancer, for instance), and we're assuming (hopefully), that they just coded it wrong...TWICE.

 

And, still others, (his $14,000 hospitalization, for example, and dd's $1,000 ambulance ride) have never been received by the insurance company (according too their system).

 

Now, the hospital wants payment of all accounts -- because they're complaining they've submitted the claims two-three times (INCORRECTLY).  

 

DH and I are busy.  Spending a day working out insurance problems *caused* by the hospital is ... well...  very irritating.

 

That is all.

[MyThreeSons]

I can empathize. Our hospital system has a terrible billing department.

 

Years ago, ds had an ER visit. We paid a little each month on the bill until our tax refund came in, and then I paid it off. Three years later, I got a notice from a collection agency. Thankfully, I had my notes from when I submitted the payment. I called the hospital, they looked it up, and agreed that I had indeed submitted it, but that for some reason they had never actually processed the payment. (I don't know why I didn't notice that it never came through -- I'm usually good about balancing my end of things.)

 

Then, a while back, dh had a little accident when we were tubing on a river, and split open the top of his head. It was a holiday weekend, so we went to the ER instead of the Dr's office for the stitches. We only had to pay a little bit because dh has good insurance,  but when I saw the total the insurance paid, it was outrageous. I checked the itemized bill, and found that they were charged for a surgical procedure dealing with a abscess in a male-only part of his body. YIKES!! I notified the insurance company, but I never heard back whether they got it straightened out and got any of their money back.

[G5052]

Now, the hospital wants payment of all accounts -- because they're complaining they've submitted the claims two-three times (INCORRECTLY).  

 

DH and I are busy.  Spending a day working out insurance problems *caused* by the hospital is ... well...  very irritating.

 

That is all.

 

I'm there with you.  At any one time, we average at least 6-8 claims out there if not more.  I work full-time from home, so getting the calls, faxes, and letters done is perpetually a problem.

 

But if you aren't on them, they'll mess things up.  Typically at least 1/4 of our claims require that I intervene.  And there's always a few that I need to negotiate because they were out-of-network, and/or we can't pay them all at once.

 

So every single week I'm working on that sort of thing.  This week it was a dental bill that insurance took 7 months to pay (thankfully the dentist's office was patient and didn't bill), but I had to negotiate a payment plan.  Thankfully we've done this with them before, and they were fine with stretching it out over a few months.

[Susan in TN]

Sometimes you wonder if they actually *read* any of the paperwork that comes through!

 

Hope it gets resolved on the sooner side of eventually!

[beaners]

Yes, we deal with this kind of thing all the time. Our most recent was a notice from the insurance company saying they can't cover my recent hospitalization because the hospital didn't say why I was there. It was an "ill-defined condition" so not eligible for insurance coverage. LOL I was giving birth! It was even a scheduled induction and they had all the paperwork ahead of time, so it wasn't like I just walked in and popped the baby out in the hallway while they scrambled to get my info! (Which is what they were afraid would happen if I went into labor on my own and needed to travel to the hospital.)

[Rachel]

I'm sorry! I spent 6 months of my life trying to convince an insurance company that I had given birth to one boy instead of twin girls I named after myself.

[Annie G]

I was billed for a circumcision that never happened. Because I gave birth to a girl. 

 

After dh had his heart attack he had stents put in at a university hospital in the next state (only an hour away from our house) and the hospital billed the wrong insurance company, thinking we lived in Wisconsin. They finally got that sorted out and made sure to note that we live in Illinois but have Blue Cross of New Jersey insurance (dh's employer is based there).

Later that year he had more stents put in and by that time we had met our max out of pocket and didn't have to pay for any more medical costs for dh. So we didn't notice that we never got anything from the insurance company about that procedure. (it was a crazy, scary time!)   Two years later we got a bill from the hospital when they discovered they hadn't been paid, and they wanted us to mail them a check. $60,000, please, and mail it within ten days, thankyouverymuch.   Um, they evidently billed the wrong insurance company again and our insurance company won't pay any claims over 24 months old. The hospital ate that cost without question.  I was relieved that they knew it was their fault but it sure freaked me out.

 

Medical costs can be so scary, and when the providers are filing the claim, it's just a waiting game to see if they did it right and whether it'll be covered. 

 

 

[Twigs]

:grouphug:  :grouphug:  :grouphug:

[TechWife]

My son had two different procedures done by two different physicians during one surgery. The insurance company only paid for one, saying the other one wasn't necessary. I contacted the hospital, who told me that they would appeal. One year later, they had not filed an appeal. The last gal I talked to told me "Oh, if they don't pay, we'll just write it off. Don't worry about it." Yet we wonder why medical costs are skyrocketing...

[Phoebe]

nm

[Annie G]

My husband collapsed at work last October, and was rushed to the emergency room of the local hospital. After two surgeries and four days in the ICU, he was doing well--until we received the bill from the emergency room doctor.  She does not accept any kind of insurance.  We are insured with a nationally recognized company.  The hospital and all the other doctors who treated my husband all accepted our insurance.  The emergency room doctor accepted what our insurance company considered reasonable payment for her services, and then billed us for the remaining outrageous amount.

 

According to the representative from our insurance company,  many emergency room physicians do not accept any type of insurance.  It is much more profitable for them not to do so.  She suggested that if we need to go to the emergency room in the future, confirm that the doctor will accept the insurance before any treatment begins.

 

That's just awful! When you go to the ER, it's an emergency! How are you supposed to have presence of mind to quiz doctors about that? And what if none of them accept your insurance?  Ugh...something new for me to worry about, I guess.

 

I'm so sorry that happened to you. 

[KatieJ]

The daughter of a friend of ours was out of state with a church youth group when she got sick. I think it was strep throat or something like that. Imagine her parent's surprise when the ER bill included a rape kit.

[TechWife]

 

According to the representative from our insurance company,  many emergency room physicians do not accept any type of insurance.  It is much more profitable for them not to do so.  She suggested that if we need to go to the emergency room in the future, confirm that the doctor will accept the insurance before any treatment begins.

 

This was an issue in our area for a brief time - the ER doc group wasn't going to resign with one of the major insurers in our area. It wasn't until the issue hit the news that the insurance company and ER doc group decided they could reach an agreement. I believe the publicity started because the insurer had to notify the policyholders that the physicians were no longer going to be "in network." Of course, this could be avoided if the hospital would employ their emergency physicians directly instead of contracting the service out. 

[Murmer]

Dealing with this today too!  Got a bill for a UTI urine test...that says my insurance won't pay...no joke you spelled my last name wrong and because you HAD to have a group number put in random numbers...no group number at our insurance and they will never match the mess you made of my name with the one on their record even if they could mind read.  GRRRR.  At least they acknowledged they made a mistake and hopefully they get it re applied...oh and the test was done over 4 months ago.

[TechWife]

The daughter of a friend of ours was out of state with a church youth group when she got sick. I think it was strep throat or something like that. Imagine her parent's surprise when the ER bill included a rape kit.

 

Most people focus on the delivery of service as being a cost factor in the rise in medical care costs, but administrative mistakes like this cause costs to rise as well. Chances are that rape kit should have been charged to someone, so the hospital will go unreimbursed for it and the they might not have captured charges that should have been on the account. Not only that, they are paying people to work in patient accounts to unravel things like this. So, the hospital ate the cost of the kit, possibly the cost of supplies that weren't billed or were billed to someone else incorrectly and were written off, the cost of the time for the person who scanned the supply item into the account and the cost of the person who had to unravel it all.

 

Capturing charges correctly is a big deal in a hospital setting - these mistakes really add up and the administration knows it. Charging out supplies has come a long way since nurses had to write things on their hand to keep up with them as they worked. 

[Butter]

When I was pregnant with Cameron, I switched to a midwife at 37 weeks and had an out of hospital birth.  I filled out the form at the OB I had been seeing that stated I was ending care with them and they would bill my insurance for the prenatal visits, blah, blah, blah.  They gave me a copy of the form and that was that.  Or so I thought.

 

It turned out someone in the OB's office just filed the form in my chart and did not officially discontinue my care with them.  When Cameron was *2 1/2 years old* I started getting an EOB denying payment for prenatal care including delivery and postnatal care.  Never mind that OB did not deliver him and I did not go to her for post-partum either.  When the first denial arrived, I called the insurance company.  They wouldn't pay it because it was too old anyway, but they were highly amused that they wanted payment for a delivery they didn't even do (the insurance company had paid the midwife who actually delivered him).  After 3 months of denials, I called the OB's office.  They insisted I had in fact delivered at the hospital with the OB.  They refused to look in my chart, however, because it was "in storage."  After 6 months, the insurance company called them with me on the phone, demanded they stop billing, and to check my chart.  A week later I got a letter in the mail from the OB not apologizing exactly, but telling me they had located my chart and discovered I discontinued care with them at 37 weeks (and included a copy of the form I had signed).  (ETA: They would've been entitled to being paid for the prenatal care if they had filed in a timely manner, but because they waited 2 1/2 years to bill the insurance at all, they had to eat the cost for those visits.)

 

I really should not have had to take so much time trying to get them to do their job and straighten things out.  I did insurance billing for a psychotherapy practice for a few years, though, so I know crazy things can happen.  When they hired me, their files were so bad they didn't even know if and when patients had paid, let alone whether they had even billed insurance companies for weekly appointments for years!  I did a lot of writing off when I worked there.  I always thought I should've asked for a percentage of what I collected rather than flat salary because I'd've been rolling in money.  Their billing methods had been *that* bad.

 

When Adrian was born, we added him to the insurance like you are supposed to, but then all his pediatrician visits were getting denied.  It took a while to get it figured out.  The insurance company had marked him down as a girl.  We had the form that had been faxed in and we clearly marked boy.  Once they finally figured it out, the insurance person said, "Well, you did give him a girl's name so you should expect things like that to happen."  Um, no.  Adrian is most definitely a boy's name.  Adrienne, which is pronounced very similarly, and perhaps the same depending on your accent, is the girl version.  And even if you think the child's name is a girl name and not a boy name, why in the world would you change the sex the *parents* marked down just because of that?!?!  Some people really do give typically opposite sex names to their kids after all!

[LisaKinVA]

Lol....this has made me feel a little better. Especially after discovering that now BOTH dh and I are being billed for cancer treatments on days we haven't been to the doctor...not to mention we don't have cancer, and are not being treated for it). We have to go to the hospital on Monday to go through every charge, get "itemized" bills (dh's itemized bill from his hospital stay literally reads "hospitalization 4 days x $x,xxx= $xx,xxx", and scan them and get them submitted properly. But first, the bills have to be correct. It's going to be a long day.