Since I was self pay for WLS- why was my Insurance Billed too?

BAF family,
I need some help.... I had WLS almost a year ago this Thursday!  Yeah!  While I am celebrating, right now, I am MAD!  I was self pay... but, I did have Medical Insurance that did not cover WLS.  Well, I was just looking at my insurance company website & low and behold, not only did I pay $15k out of pocket which was to cover everything, I also just realized that my insurance company paid the hospital & dr close to $30k for the same dates of service.

So now, what are my options?  Do I report the hospital to the insurance company, do I approach the Dr's office or what?  Right now, I feel cheated out of $15k that I can TRULY use about now.

Any ideas/thoughts!  Need to get on this immediately.

Thanks!

WOW!  I can understand that being maddening, but what a great unexpected blessing!! Hopefully it won't take them too long to get this rectified, but I would suggest writing  a certified letter to the hospital's billing department with proof of payment from yourself & a copy of the payment that the hospital recieved and ask for a reimbursement pronto.   Give them 30 days to respond, but follow up with them about a week after you've received confirmation that they have it, and speak directly to a supervisor to express the severity of the matter & that you expect them to expidate the refund due to their oversight. 

Ok I edited to say, the letters need to be sent to whomever benefited from thepayment i.e. the hospital the doctor or both.  Even if it's the doctor, you still need to send the letter certified, that is proof that they received the information & is documentation for you to present if you need to proceed further.

Thanks! the crazy thing is that the hospital is STILL billing me - saying I owe them $3k... That is CRAZY to me as they were paid $30k and they billed my insurance for $50k.  That seems crazy as the surgery was only $15k all inclusive....

Sounds like someone is trying to get over.....

That is messed up.  Do you still have the copy of the original bill that they presented to you?  If you present to them copies of that, along with the previously mentioned items & include in the letter the fact that 1# no addtional monies are owed them #2 they have been over paid (spell out in the letter where payments came from) 3# that if immediate resolution isn't taken you will get the insurance company  involved and  file complaints with whatever regulating bodies (state/federal)  involved to look into the matter of blatant fraudelent billing practices by the them.   I'm not a lawyer, but have a lot of experience working customer service in different fields, but someone else may have additional suggestions for you as well. 


Question:  They got $15,000 from you and $30,000 from the hospital?

Yes, $15 cash fron me and $30 fron the insurance company

my insurance policy does not cover WLS....  so what they were billed for I am not sure but, it is for the hospital stay, medicine etc... - all of what was supposed to be covered in my fee.

It wouldn't hurt to call your insurer & just question them on how it was submitted & why it was paid.  Maybe there was a policy change that you were unaware of.  It's possible that your surgeon presented enough evidence to overiride the ruling or that there indeed was a change, but still for them to have still submitted it after collecting money from you is considered fraudelent.

The more ammo (documentation & facts) that you provide them with from the offset will help you to resolve this on your own.  Make sure your letter is very detailed, including if you can recall names, dates, places and times of how billing was discussed & what your expectations were after each conversation.   Also,ask your insurer if they can send you proof of payment & the detailed benefit plan that confirms why they paid for that procedure.

I was able to pull the explanation of benefits from the insurance company website so, I have that. I also have my bill from the DR showing what I paid.  I am also going to call the hospital as they are the ones billing the insurance company.  thanks, I will keep you posted.