Hospital billing... you can't make this stuff up

My son was born in June, and we're still working through all of the bills from the hospital. I got a bill for our co-pay in late summer, which I paid. I was covered under my insurance, and my son was covered under my husband's family plan, with mine as "secondary insurance" for the first 30 days.

In the fall, I got a bill from the hospital for his birth. It had originally been paid by my insurance, and then once the coordination of benefits was established and mine was secondary, they reversed the charge (or something). So, my husband's insurance needed to be billed. Fine, easy... right?

I have gotten no fewer than 4 letters from the hospital since that time, saying that I owe about $4k because insurance didn't pay. But every time I log on to my husband's insurer site, I see no record of the claim being submitted at all. So I've diligently called every time, they have noted that I've called and said they would bill Aetna... and they still haven't. They've had issues submitting electronically, or something. Who knows - but this has been going on for at least 4 months. Last week I got a "final notice, this is going to collections" letter, so I called AGAIN, and was told this time a supervisor was going to physically walk the claim over so it gets submitted.

I logged on to Aetna today, and saw that the claim is finally there- with a denial code that says "You do not have to pay this charge. That is because the provider did not send the claim to us within the required time limit."

Sorry, hospital... I really, really tried!!! SMH.

When my eldest was born the office staff of the pediatrician who saw him at the hospital didn't submit the bill for an extremely long time. I can't remember exactly how long, but I know it was well over a year. But even after I finally received the EOB that showed I owed nothing the doctor's office kept sending me past due notices. I wrote to the division of consumer affairs and they are looking into it, but haven't yet gotten back to me (or they have and the post office lost it). My son turns six in August and I have received copies of the bill for his birth asking to be paid from the pediatrician within the last few months. I supplied my insurance information to everyone in a timely manner, HER office staff dropped the ball and her contract with the insurance company states she has a limited time to submit claims. It sucks that she won't get paid, but it isn't MY fault.


@spontaneous, exactly. I know they have a record of me calling every time, because each time they've said "oh, I see that you called before..." So there's really not much I can do, but I am hoping they don't try to bill me again.

I have found that if you get both the billing department and the insurance company on a conference call with you that you can resolve these issues quickly. I have been through this too many times to count. It's the only thing that I have found that resolves the billing issues.

When my son was first born, claims regarding his birth kept getting denied because he has the same name as his father. His father was on my insurance for a little while and then he was removed, so the insurance kept replying to the hospital that the individual was not covered. We had to make multiple calls and have my HR department explain that this was a newborn and to pay attention to the birth date to differentiate the individuals. It was eventually resolved, but I feel your pain or having to go through this nonsense when your hands are already more than full!!

suzyc said:

I have found that if you get both the billing department and the insurance company on a conference call with you that you can resolve these issues quickly. I have been through this too many times to count. It's the only thing that I have found that resolves the billing issues.
I didn't conference call, but in my case the doctor's office told the same LIE to me and to the insurance company, that they had submitted the bill immediately. The insurance company had no record of a timely filing but said that if they produced their voucher (proof of submitting a bill) then they would agree to pay the bill. The doctor's office couldn't explain to me or the insurance company why they didn't have a voucher.

pmartinezv said:

When my son was first born, claims regarding his birth kept getting denied because he has the same name as his father. His father was on my insurance for a little while and then he was removed, so the insurance kept replying to the hospital that the individual was not covered. We had to make multiple calls and have my HR department explain that this was a newborn and to pay attention to the birth date to differentiate the individuals. It was eventually resolved, but I feel your pain or having to go through this nonsense when your hands are already more than full!!
I am worried about this with my youngest since he was born on my husband's birthday. His name is different, but his date of birth is the same except for the year, and when you use the two digit year (15)rather than the full four digit year (2015), then the only difference between their dates of birth is ONE digit. That is a screw up waiting to happen.


The hospital credited my account and kept billing my sons' account because of the difference in our last names. Similar to your story- That took months of calls and letters. before we finally said lets let's try this. The hospital was just going to sit with the positive $x,000 in my account while it repeatedly billed the negative -$x,000 in his.

spontaneous said:

pmartinezv said:

When my son was first born, claims regarding his birth kept getting denied because he has the same name as his father. His father was on my insurance for a little while and then he was removed, so the insurance kept replying to the hospital that the individual was not covered. We had to make multiple calls and have my HR department explain that this was a newborn and to pay attention to the birth date to differentiate the individuals. It was eventually resolved, but I feel your pain or having to go through this nonsense when your hands are already more than full!!
I am worried about this with my youngest since he was born on my husband's birthday. His name is different, but his date of birth is the same except for the year, and when you use the two digit year (15)rather than the full four digit year (2015), then the only difference between their dates of birth is ONE digit. That is a screw up waiting to happen.



My daughters have the same last 4 digits of their SS#, the same middle name (my maiden name) and last name. If that's not a major paperwork snafu waiting to happen, I don't know what is.

Tarheels, it's ridiculous you're going through this!!


In order to add a comment – you must Join this community – Click here to do so.

Sponsored Business

Find Business

Real Estate Listings

Rentals

Advertise here!