Advice dealing with Hospital charges

One saturday my toddler was playing when he fell on hard wood floor and had contact seizure. This was first time seizure and we immediately called 911, and
he was taken to ST Peters University Hospital, NJ. We live in upstate new york and were visiting friends in NJ. We called our insurance company for precertification; however, they were closed, so precertification was not completed.

The hospital submitted claim of $24000 (for hospital stay) to our insurance company, however, hospital did not submitted needed clinical paperwork to prove that his 2day ICU stay and 1day general ward stay was necessary. The insurance company is supposed to cover 100% of the cost; however, since they have not received all paperwork, they have already rejected the claim once on grounds that hospital stay was not proved to be necessary. Now, the case is in reappeal process.

My husband has called hospital billing department, however, he always gets voice mail where he leaves the message to send all documents to insurance company. Once in while when he gets live person, they are quite rude, and they say they would handle it. Last week when he called hospital billing department they said they have sent all clinical paperwork; however, when he called insurance company after 4 days to confirm it, the insurance company said they have not received the paperwork. The insurance company has told that if case gets denied this time they would not honor it and we would have to go to court.

We are trying our best to talk to hospital to send all paperwork; but incase claim gets denied what are our options. Also, can we talk to some authority in hospital to let them know how lousy is their billing department.

Thanks for all your advice.

I would go in there in person during normal normal business hours and not leave until you get the documentation personally. Its alot harder to ignore someone standing there than it is someone over the phone. Though this does run the risk of still not working or the person who legit needs to do it not being there.

If you must call then I would ask to speak to a supervisor. Also if your not already start taking down the names of everyone that you talk to and what they said they would do etc so when you talk to a supervisor you can say X said they would do this on Y date, but they didn't or it was lost so now its having Z consequences for me so I need it done right now.

And of course if you were an illegal alien who pumped out a kid it would all be free.

American taxpayer, you're screwed!

NewToFatWalletUser said: And of course if you were an illegal alien who pumped out a kid it would all be free.

American taxpayer, you're screwed!

did the bus boy pee in your coffee at breakfast?

"the insurance company said they have not received the paperwork. The insurance company has told that if case gets denied this time they would not honor it and we would have to go to court"

Wont anyone from your insurance company call the hospital billing office to fix this?

LordB said: I would go in there in person during normal normal business hours and not leave until you get the documentation personally. Its alot harder to ignore someone standing there than it is someone over the phone.

She mentioned in her post she's from up state NY. Aka, she's probably at least a 3 hour drive.

LordB said: Also if your not already start taking down the names of everyone that you talk to and what they said they would do etc

This is good advice.

It is a negligence on hospital billing department's part. IMO you can let billing department know that if they cannot provide the paperwork needed to resolve the issue, you have no choice but talking to the litigation department of the hospital about their negligence.

I'm going to give some counter-intuitive advice based on my experience. I had some billing issues with a hospital that didn't bill my insurance carrier (Blue Cross MA) correctly. When I was sent the full bill, I waited several weeks (not the best idea) and then called the hospital billing department. By the time I called the hospital, they had recently sent the bill to collections. I then called Blue Cross and managed to get an amazingly helpful person on the phone. She called the hospital herself (she even put me on hold with my permission in case she need more info) and got them to fix their mistake. The BC person I spoke to actually thought it was her job to fix my problem and pay the hospital bill.

So, it wouldn't hurt to try calling your insurance company directly and asking them to contact the hospital as you have been getting nowhere with them. It might or might not work, but at least they will be more likely to answer their phones than the hospital billing department. My experience is a little different than yours as my insurance company knew my bill was covered by my policy, but the hospital hadn't sent them the bill.

I hope your son is doing well!

I have been in similar situations several times, and here is what I did:
- Do not call anyone (like you, I was pretty much always getting to a voicemail or to some rude person that did not have a clue nor desire to help).
- Do not visit them in person (they'd have to pay me for time off work and travel expenses if they wanted me to visit them).
- Print a nice letter, clearly stating that their insurance claim, such and such number was rejected for such and such reason, and if they want their money, they will need to resubmit it, and have the errors corrected. I also mention in the letter, that I have neither funds nor desire to pay for their mistake, so, unless they file the corrected claim before deadline, they are going to see me in court.
- Mail the above letter to their billing department, and a copy to management via certified mail.

So far, this strategy has worked for me every time (once, they stopped sending me the bills without actually trying to collect from insurance as well - I can only guess why, perhaps, the charge was not even legitimate).

Now, I am not a lawyer, and your mileage may vary obviously. When I do this, I always half expect that they'd call by bluff, and send the debt to collections, so I am ready to take it to the end if I have to - take a credit hit, make court appearances etc (I'd rather not be able to refinance on super good terms than bend over for these jerks, but I understand that everybody's' situation is different). Just saying, that having done this 6 or 7 times in the past, this has never happened.