Ins Co had outside agency audit hospital bill and then paid. Now what?

Hello Friends, Me Again! My hospital bill with Ocean Springs Hospital, MS for an uneventful 3 day stay was about $34,000. My insurance company found that to be awfully high and sent the itemized bill to an outside auditing agency. The audit agency did their work and claimed the hospital overcharged me and my insurance by about $20,000. I went out of network (had to, long story) but my ins co tells me these "excessive" charges are NOT above reasonable and customary, they are simply charges in excess in what I could have incurred. My Ins paid in full the charges deemed ok by the audit agency ($15,000)and sent a letter explaining the audit, along with the check, to the CFO of the hospital. When I got the EOB I called the ins right away and the nice lady there (that I've spoken to since day one of my start on this journey) promised me this was not a R&C issue and that I would NOT be responsible for the charges deemed excessive by the audit. I reminded her that they were out of network and wondered if the hospital would see it the same way! I called the hospital and a very snippy lady said that I would indeed be responsible for the remainder and that they did not honor ANY outside auditing and that the audit must be done on their own premises with their own internal auditor and that my ins co would need to call them and make arrangements to travel to MS and perform the audit!! (Hello! What ins co is gonna do THAT???) Well now, one month later, (and after requesting an audit of my acct myself with the hospital)I finally get the dreaded bill from the hospital and they say I owe it. WHAT CAN I DO?? The ins co is telling me I am not responsible becuz the hospital bill was excessive according to the auditor, but the hospital is saying I am!! I am terrified, I am scared, I don't know what to do or if these "external auditing agencies" have any clout??!! What's my next step? How can I appeal this? Anybody have their surgery done also at Ocean Springs (either IN or OUT of network) and can give me an idea of what they were charged?? And what their insurance paid? Maybe my ins co's auditor is way off base, maybe the hospital is! HELP PLEASE! Thank you and Blessings in advance.......

We greatly appreciate your interest in helping us build our Q&A database. To discourage vandals from posting garbage, however, we require people to register before posting.

You must be logged in to post an answer. Click here to log in.