HELP!!!!!!!! Health Insurance Issues?

Question

I gave birth to my daughter, my insurance was oxford and my daughter's was medicaid. The hopital got paid for both me and my daughter from both oxford and medicaid. The pediatrician whom i have never seen, who i guessed saw my daughter when she was born did not bill medicaid, and has sent me to collections. I had no knowledge of her, i never gave her any of my information but know i'm finding out that she has billed and sent me to collection. Isn't it against the law to to bill the patient the full amount if the patient had insurance at the time. she was the one who did not get the correct information because i never met this doctor or spoke to her.

Answer 1

No. It's not against the law to bill a patient. It's the patient's responsibility to make sure the provider has the proper information, and if the plan billed denies the claim, for whatever reason it decides to, the claim then becomes the patient's responsibilty to deal with. (You usually sign paperwork to that effect before services are rendered.)

In a hospital setting, every entity is separate and can (and do) bill separately. This will include the hospital, any labs involved, in the case of a newborn: the OB-GYN, and any house pediatrician who examines the child. In the case of a newborn, the hospital bills are often covered, but the pediatricians' bills are sometimes a fight. They usually bill under the mother's plan, because newborns are technically covered under the mother's insurance id# for the first thirty days of life.

Regardless of if you provided your information directly to this provider or not, they were probably provided with it by the hospital -that's commonplace. I'm a little confused about how you're just now finding out you've been billed for it - unless your contact information was incorrect or you ignored anything the provider sent. (It happens - especially if it's a name not recognized.)

What you should do is call Oxford and ask them to reconsider the claim, since your daughter was under thirty days old at the time of service. If they do not reconsider the claims - which Oxford's policy is generally if the baby isn't added to the plan, they don't pay. (Unless you're in New Jersey, then they have to pay.) In which case, call the doctor's billing office and provide them with the medicaid - there's hardly ever a timely filing limit with medicaid.

Answer 2

It is not illegal to bill a patient for services rendered. Dr's bill insurance companies as a courtesy to the patient. Newborns are always checked out by a pediatrician in the hospital. They will usually take the insurance and demographic info from the chart. Either the dr didn't do this or the info wasn't on your daughter's chart. Give the info to the collection agency and to the doctor's office as well. It is in your best interest to get this billed since you may be running up against a statute of limitations for reimbursement. Your insurance may cover your daughter and in any event they should be billed for a denial since Medicaid will require that before considering the charges.

Answer 3

Contact the doctor's office and provide them with your daughter's Medicaid information. You should be able obtain the doctor's phone number from one of the billing statements you've received and/or the collections agency.

Most likely, the doctor's office simply didn't have knowledge of the Medicaid. Its not "against the law" to send a bill to you if they didn't have all of your insurance information. You should be able to handle the situation simply by calling the doctor's office and providing them with the correct info.

You didn't mention, however, how much time has passed since your daughter's birth. Be forewarned that if you've been ignoring statements from the doctor's office and/or collection agency and too much time has elapsed for them to bill your insurance company, you can be held liable for the bill. (Hopefully this isn't the case - you should be okay if your daughter was born this year. I just wanted to mention the possibility, since it was hard to tell from your question if this happened recently or several years ago.)

Answer 4

From a benefits administrators perspective, I would suggest you contact Medicaid to ask for guidance. You want to make sure that Medicare will pay the bill if/when they receive it and that there are no time limitations on when they pay after you have received medical attention. You can also contact the hospital too. Typically. bills are sent to collections after several attempts to get the bill paid - have you talked to the doctor's billing department? Make sure to keep notes/records of all your conversations. Hope this helps and good luck

Answer 5

direct whoever is trying to collect from you to your insurance company, or in your case, medicaid... let them handle it...