Referred us to hospital, then refused to pay?

Discussion in 'General Parenting' started by susiestar, Jun 30, 2005.

  1. susiestar

    susiestar Roll With It

    Brandon went to a certain psychiatric hospital where his doctor is affiliated. The insurance co told us this was the place to go to. They also told us this was one of the approved docs. We did the precertification on the mental health thingy. The hospital did also.

    This was for his May hospitalization. We just got the paperwork and ins refused to pay because the hospital was out of network???

    It is in their directory, they gave us the name over the phone, and it shows on their websearch engine?

    When I called them about it I was told that it was just "how it is" by a snippy young lady. I refuse to accept this, especially as he has had a second hospitalization since then.

    What steps should I take now?? Do I get the hospital accounts people to call? Or do I call and get a manager, or send a certified letter? Or do I ask someone in human resources to help with this battle?


  2. susiestar

    susiestar Roll With It

    I finally found a contact phone number that will give me a live body and guess what???

    The bills aren't being paid because the hospital hasn't answered all of the insurance companies questions!! Until all of the questions are anxswered, they will not pay.

    So first thing Tues I will be calling the hospital to demand they send the info to the insurance co. (I tried Friday, but the people were out).

    ARRGGGHHH. Susie
  3. OTE

    OTE Active Member

    Well that's progress. I'd still go with a certified letter to the hospital billing dept. In that I'd make it clear that I will not pay any co-pays, deductibles or be in any way responsible for the bill if they do not cooperate with the insur co. That may get more attention than a phone call. And if it's still not resolved in a couple of weeks call your state hospital billing/ licensing board and ask them for help. They'll call the hospital and get more attention than you do.

    FYI in states I've lived in there's legal protection for you if they try to get the whole bill from you later if you've put them on notice up front that they're not getting paid because they're not billing correctly. So the letter is good legal protection in case this ends up going on for a long time.
  4. bigblueagain

    bigblueagain New Member

    I would also call back to the insurance company and the hospital billing dept and ask for supervisors to register your complaints. The insurance company has to record your complaint and offer you a written appeals within a specified time frame. Be sure to keep all dates and names of everyone you speak with. As I have said many times before, it is not always the big bad insurers that cause trouble. Many times the hospitals are sending out their bills to be filed, or the coders in the medical billing or records offices don't get correct medical and diagnoses codes to the insurers. Also once again HIPAA is rearing its ugly head, as what used to be easily given over the phone now has to be written or transported electronically. BLUE
  5. ncylou41

    ncylou41 New Member

    Sometimes claims are held up pending info from you or the facility or doctor. When you get your statement of benefits there should be a code on there telling if paid, and if not, why.

    My own therapist hasn't been paid since I started with him in April! He has to send a copy of his certification or license (which I'm sure he has) to be paid. I keep taking the SOB's into him, he's owed about 1K by now. I did my part, they have to do theirs.

    If there is nothing you have to do then it's on the hospital. Just keep forwarding the info to them.