How do you fight unfair hospital bills in the US?

[johnthomasmacdonald]

As I've said all of my experience with hospitals and doctors is in the UK where this stuff doesn't happen, so i don't know how or where i fight them.

I had a colonoscopy in May I used the hospital that was in network ( St. Claire's in NJ). The doctor would have preferred using the surgical suite connected to his office but my insurance wouldn't pay that - they would only pay for the in network hospital.

I checked with the hospital, the doctor and my insurance company prior to the procedure to make sure it was covered. The day of the procedure, I gave them my insurance card, my driver's license and paid my $200 co-pay.

I was out the same morning - no problems. About 6 months later I received a bill from the hospital for $423.

I have the statement from my insurance company ( horizon blue cross blue shield) showing their payment and that I owe $0.00.

I have passed all this off to their billing department and have talked with a supervisor but all they say is: " we've looked into it and you owe $423 ".

Horizon says that they can't Bill me any additional amount since they are in network, if they are unhappy with the amount they received they are supposed to complain to BLue cross, not to me.

My experience with my billing and my sister's is that in the US the medical facilities try to get everything they can squeeze out of you whether or not they are entitled to it.

This is just one bill, but every single time I have used any health related service here it has been a huge hassle ( as i've mentioned that blue cross refused to pay anything for my sleep apnea diagnosis and then when i paid for the diagnosis entirely by myself, they then refused to pay the new sleep doctor I went to for treatment " as a pre-existing illness".

Now I'm getting the hospital billing department calling me at home in the evenings -

Where do i take this? - I've called the NJ Bureau of consumer affairs but they were fairly useless and basically kept saying that i should send the hospital my statement and a letter summing up the issue - I've already done this twice

[DiverCTHunter]

Write a letter detailing what happened, include copies of any paperwork and have it notarized.

Send a copy to the hospital, your state Attorney General, state Medicaid office and state Insurance Commission. The ones to the AG and the Commission will need to be sent registered mail (~$5/letter).

If you have a local television station nearby, contact their Consumer Affairs desk as well. "Big Bad Hospital" stories like this are classic slow-news-day material.

[jencat824]

I would do all the above AND contact the department that handles hospital CONTRACTS at BCBS, tell them what happened, the hospital is breaking a contract they have with BCBS and the insurance company needs to be involved in helping you resolve this. Don't just get the 'person who answers the phone' but request the 'contract' department, be ready to keep requesting supervisors until you get the person in charge of the contract for that hospital. The hospital is breaking their contract and needs to be held accountable. In the meantime, tell the callers in the evening that you have a statement that says ins had paid and you are not responsible for more, you are contacting ins co & they need to quit calling you. They won't actually stop calling, just keep repeating this to them until the contracts dept resolves this issue for you.

Good luck,
Jen

[StuUnderPressure]

I agree with jencat824 - Your best avenue is through BC/BS

I would only add that you may be better off if the insurance dept of your employer called BC/BS on your behalf.

[chunkyfrog]

Your personnel office should call the guilty parties and make them behave.

[Bons]

Last time I had a similar problem, I walked the bill into the doctor's office and kindly asked the billing clerk to call my insurance company in my presence so that all three of us were having a consultation on the matter at the same time. That worked.

[greatunclebill]

when i have a billing problem, i make a copy ot the bill and a copy of the insurance form that shows the cost breakdowns. i attach them to a letter that i send to the billing department stating that i owe nothing and for further information they should review their contract with the insurance company and direct any further questions to the insurance company. it never goes further than that because they are breaking their contract with the insurance company. if it ever goes further, i will take my paperwork to the insurance office and it will drop dead right there. as part of being in my insurance network, providers agree to accept the insurance payment as final payment with no provisions for above and beyond charge. make sure your insurance has this provision, that they do not permit above and beyond charges.

[xenablue]

Ditto what greatunclebill said. This is the most effective way to make the hospital look at their billing to make sure it's correct (and to plant the seed that they can't overcharge you what their contract states with the insurance company) - otherwise they'll just keep pestering you, and eventually send it to collections where it goes on your credit record.

cheers,
xena

[Janknitz]

The hospital is attempting to do something called "balance billing". See http://healthinsurance.about.com/od/cla ... illing.htm

Balance billing is the practice of a health care provider attempting to bill you for the difference between the insurance contracted price and their own price. Most contracts which insurers have with providers prohibit balance billing, and in 47 states it's prohibited by law.

Sometimes a polite, well-researched letter (covering your insurer's policies and your state law) reminding them of the prohibition against balance billing (cc to your insurance company) will get them off your back. Otherwise you can file a FORMAL, WRITTEN complaint with your insurer and your state regulatory agency.

[johnthomasmacdonald]

by greatunclebill wrote: "

when i have a billing problem, i make a copy ot the bill and a copy of the insurance form that shows the cost breakdowns. i attach them to a letter that i send to the billing department stating that i owe nothing and for further information they should review their contract with the insurance company and direct any further questions to the insurance company. it never goes further than that because they are breaking their contract with the insurance company. "

I've already done that Twice to the hospital billing dept with no result

As to the insurance company- I've only dealt with horizon blue cross by phone - i guess they have an office somewhere - when i talk with the insurance company by phone, they totally agree with me and claim that they have refaxed over the bill to the hospital showing that i owe nothing - to no effect

[chunkyfrog]

Then they are harassing you--which is actually something they can be SUED for!

[Cpap momma]

Th hospital has a customer liasion or patient care advocate. Start there first. Many times things can be solved without sending to ag's and such.

[qmx]

I have a friend that oversees a billing dept. in a large hospital. Take $50 cash to the hospital billing department, ask to speak to someone in authority, offer the $50 cash and explain that you feel the bill is unjustified. Be clear that $50 is all you will ever pay and that they must write off the rest. If they do not accept it, do not pay the $50 and state that you will not pay their bill of $400+. ... that the $50 is your only and final offer. Usually they will grab the cash because it is a sure thing. Make sure you demand a receipt showing forgiveness of the balance. DEAN

[ems]

What I did in a situation similar to yours: I paid $10.00, sometimes $5.00 a month until the bill was paid off. That was the only way to get them off my back. No more letters or telephone calls.

I was told that in a hospital/doctor, etc., situation, as long as you pay 'something' they can't do a thing.

In my case totally accurate.

[Janknitz]

Don't pay them--you don't owe them. But you do have to clear this up so they don't take you to collections.

And they should not be harassing you on the phone. If you tell them to stop calling you and they fail to comply, they are violating consumer debt laws and you have a further basis for a complaint.