bill being sent to collection agency?

Question

I have a hospital bill that the insurance initially denied because the emergency room doctor did not indicate that the service was medically necessary - the insurance company told me that. I appealed the decision and my doctor wrote a letter and am waiting on that decision. When I have received bills from the hospital I have returned them twice with the infromation that I have appealed to the insurance and am waiting on a decision. The third time I sent a certified letter which they did receive. Today I got a letter that said if I don't pay the $800 immediately (which I don't have) that it would be sent to a collection agency. I'm not sure what to do at this point - I am not refusing to pay, just want to find out the decision on my appeal first. I'm also leary of anything the hospital tells me since they told me stuff like I wouldn't get a notice from the insurance if they denied the claim - (not the insurance company story) and a different reason for the denial.

Answer 1

Send the hospital's billing department a letter explaining that you have filed an appeal on the denial from your insurance for the visit, and that you expect a result within 30 days from today, and that you will keep them aprised of the situation, and to please hold your account for those 30 days, and if you appeal is denied, you will make payment arrangements. Keep a copy of this letter. Send it to the billing department with a return receipt requested - this way, you can prove they've received the letter explaining your intent, and that you're not ignoring them.

Also, harass the snot out of your insurance - tell them you're being threatened with collections. Sometimes, if you get a human being at the insurance with an ounce of compassion, that lights a fire under them.

If you get sent to collections, let them know what's going on - pretty much read them the letter, and offer them a copy of it. Some agencies will work with you. Although, I don't understand why the hospital won't work with you - they lose a minimum 30% off the top (can be as high as 50%) if they send an account out to collections.

Answer 2

The hospital is probably trying to jam it's superinflated bill past you. I think I would find out what the insurance company would pay for that service (this is not even close to what that bill is for) and then go from there.

Generally I find that when bills approach $800 the actual insurance company payout would be closer to about $125 (or less). It is not uncommon for hospitals to bill greater than 900% more than the insurance company would pay out.

The insurance company will generally pay for emergency room services up to the deductable because they know that the Doctor told you it was medically necessary and/or you were not able to make a decision as to it's necessity. They also know that Emergency Physicians do a lot of tests on just CYA feelings and not always medical necessity so they deny them and make the hospital follow the correct procedure.

The longer this takes the less money the hospital will get. You should call the hospitals ombudsman and ask for assistance. This is generally the person who gets involved before bad things happen like... you call your local news stations consumer advocate and have them deal with the hospital during the 5o'clock hour. The hospital may even have a fund set up for those who cannot afford their bills. A certain CT hospital (cough, cough Yale) was shafting the poor and got caught. Here is the CT statute relating to hospitals but whatever state you are in may also have such laws. http://www.cga.ct.gov/2004/rpt/2004-R-0103.htm

Good luck with this.

Answer 3

ultimately you are responsible for the bill whether your insurance company denied the claim or not. Usually healthcare providers file on your behalf as a courtesy. I would call the hospital and see if you can work out payment arrangements. In the meantime, if the insurance company comes back to pay the bill, the hospital will owe you a refund. at least this way you won't get sent to collections.

Answer 4

This really pisses me off too and you have my sympathy. I think what you could do is pay the hospital bill directly and afterwards do whatever you can to collect it from your insurance company. If you can't pay it all at once, then ask the hospital to allow you to pay it little-by-little in monthly installments. If they refuse to go for it, screw them, do it anyway. As long as they see you paying regularly, they'll be reluctant to send it to collections because they know that the collections agency will take out a chunk for themselves if their services have to be used. Keep in mind, insurance companies typically pay a hospital only a small percentage of what an uninsured patient would have to pay out of his own pocket, even for the exact same procedure. Your insurance company may refuse to reimburse you for a large portion of the bill because of this. In this case, you can sue the hospital or doctor in small claims court for the difference because he screwed up his paperwork in the first place.

I just have to say that if you had been treated in Europe or Canada, you could've just walked in and out of the hospital and there wouldn't even be a goddamn billing department or any insurance company bastards for you to have to deal with. Best of luck!
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Answer 5

call the billing department at the hospital and explain your situation to them. Let them know that you do not have the money to pay the 800 at this time and that you are negotiating with your insurance company to make payment. If your insurance company still refuses to pay the bill, send the hospital $10.00 a month until it is paid off. In fact, while you are arguing with your insurance company, go ahead and send the hospital a small payment. I dont think they can turn you in if you are making payments that you can afford.