Question:
HELP!! Ins paid less than half of hospital charges!!!!!!!!!

Hello All!! Ok, for the first time since a couple weeks post-op, I am feeling NAUSEOUS!!!!!! Yes, I did go out of network and the hospital blackmailed me into signing a paper saying their fees may not be R&C and that I would be responsible for the difference, but. . . I got the EOB today and my insurance didn't even cover HALF of the hospital charges!! This leaves me with about $20K!!!!!!!!!! =( I'm terrified. Anyone have this problem and get it resolved or at least helped?? What can I do?? My husband will KILL me when he finds out! I was supposed to have $500 deductible, $2000 max out of pocket after which they cover 100%. . . so he thought we were gonna be out $2500 not $25,000!!!!!!!!! Please please. . . help. -Christi    — ChristiMNB (posted on July 24, 2001)

July 24, 2001
I do a lot of financial counselling for the hospital I work for. Your's is a story I hear several times a day. Did your insurer tell you in writing what your out-of-pocket expenses for going out of network would be? If you have the letter, contact the collections department at the hospital and let them know that the insurer didn't pay the claim correctly....they'll take it from there. They would rather bill the insurer than bill you. If you didn't have it in writing, call your insurer's customer service department and ask for a supevisor. Be calm and professional and explain that you believe that your claim wasn't processed correctly....based on what you were told prior to your surgery. Ask him/her to review the payment. If they did process the claim correctly and you do owe the hospital $25K, call the hospital and explain your situation. They might be able to set up a payment plan or offer some financial assistance. Start now. Be proactive. Be calm, controlled, and professional in your dealings with both the hospital and your insurer and they'll be as fair as possible with you.
   — [Anonymous]

July 24, 2001
I guess going out of network would have been my first clue. Did you get something in writting saying it would be covered at a higher amount? Did you fully understand your benefits? I realize how scary this can be.. but I guess it seems you should have fully researched this before going for it. I don't buy a car without knowing about it.. I wouldn't buy a house without seeing it and it passing inspection etc. I have to realize because I have worked in the insurance industry that I have a VERY good understanding of benefits.. and I take a great deal of time fully reading through everything so I know what I am dealing with. I wish that everyone could do that. I think the public in general doesn't understand their policies. Ask questions.. get it explained to you in terms you understand.. its your right and your resonsiblity at the same time.
   — [Anonymous]

July 24, 2001
Check to see if your insurance has an out of network Max you have to pay. Most insurances do. Secondly get a print out from the hospital on what the charges are. That sounds outragous on the amount you had to pay. After you make sure that is correct then FINALLY make payment arrangements. Good Luck!
   — Donna J.

July 24, 2001
Thanks for the heads up. I have United Healthcare Choice Plus, they have told me they will pay this as a non-covered benefit, $250 deductible 80/20 with a 3000 max out of pocket. I have never received a copy of the letter, and will be picking it up tomorrow when I visit the Dr for my last pre-op. If it does read that I am only responsible for $3000 out of pocket does that guarantee me that I will not have to pay more? Does anyone know?
   — Robin P.

July 24, 2001
Christi, I'm sorry about the situation you find yourself in. However, "blackmail" is a serious change, and a criminal offense. Are you saying that your Hospital told you that if you didn't sign that form, that they were going to "spill" some dark secret about you to "whomever"??? If I were you, I would get a lawyer, and sue the pants off that Hospital. If you remain quiet, the Hospital will feel they can continue to use private information against others. Again, "Blackmail" is a serious charge to be saying against someone. But if it's true, you should seek legal relief. Good luck to you in whatever you decide. Kevin
   — meilankev

July 24, 2001
Christi, Unfortunately, even though your insurance company paid what they consider the customary and reasonable amount, it doesn't sound like the hospital accepted that as payment and since you are out of network, they are not contractually obligated to accept the lower amount. I will be having BPD/DS in October and my surgeon is out of network, but my hospital is in network. My surgeon's fee is $12,000 and the office expects you to pay the $12,000 upfront and they bill the insurance company, or you have to wait for a date while they bill the insurance company and then you are required to pay the difference between what the insurance company considers customary and reasonable and the actual amount of the surgeon's fee. If the insurance company doesn't state in writing how much they are willing to pay, then the office goes back to expecting the $12,000 upfront before you get a surgical date. It sounds like the paper you signed from the hospital made you responsible for the difference between what the insurance paid and what the hospital charged. What you should do is contact your insurance company immediately and see if they will cover the difference between your out of pocket maximum and the amount the hospital charged you. If they say they won't cover it for some reason, contact the hospital and you can set up a payment plan. While they may want $25,000 upfront, they will settle for a payment plan, as long as you make payments. If the insurance company sent you the amount they would pay or the amount you would be responsible for in writing, make sure you make copies of it. You can then fax it to someone at the insurance company once you get their name and fax number. (Make sure you write down who you spoke with, when you spoke with them and their extension number, so any follow up does not fall through the cracks!) Good luck! *hugs* Anita
   — Anita N.

July 24, 2001
My husband works in the hospital administration, and the paper that you signed is a normal standard form. It's not blackmail. Anyone that enters a hospital for surgery, emergency or what not, signs forms stating that they are responsible for the bill, in the event the insurance comes back and says no coverage. Even most doctors offices make you sign that type of document. Check the fine print. Now your bill seems to be way to much, go over your bill. Trust me I know ,I had a baby a year ago and the hospital charged me over $3,000 in stuff I never used or got. Then call your insurance company, find out what is going on. Sometimes, insurance companies pay partial payments, one at a time, and possibly the hospital hasn't gotten the rest, had that happen too. Then if you have it in writing what the insurance company said they would pay, make copies, send them to the hospital and to the insurance company. A lot of the times the hospital will go to bat for you and re bill , especialy if they know the insurance company is in error. And if all else fails, and you are responsible for the bill, most hospitals will take payments. But all in all, tell your husband what is going on. I'm sure that he would be less angry if you told him upfront what is going on, then to hide it from him.
   — [Anonymous]