hospital bills

[jacquiev]

The problem we have is that we did not know that the hospital was out-of-network for mental health issues. The hospital was in network for regular medical. It was an emergency admission.

The insurance company told the hospital that they were not in-network and they would move the patient to an in-network hospital. the hospital failed to tell us (I think on purpose -- they are in the red).

The insurance company tried to negotiate with them for a one-time contract -- the hospital refused. They want the full amount. We would have to pay over 5,000 just for the hospital and none of the doctors we learned are in-network either -- another 3,000.

Can anyone offer any advice.

And we are still paying for therapy on a weekly basis. All this is just too much!!!

 

[tiredmommy]

Did you advise the insurance company of the emergency admittance? Most contracts give you 24 or 48 hours to contact them.
-TM

 

[OTE]

Call your state hospital licensing dept in Albany. They'll have a hotline for hospital billing disputes. Most state laws say that if you were not notified when you could have done something about it they can't come back at you later.

If you need to, hospitals with an ER have to offer some kind of financial assistance program. Again, by law you don't have to pay them in lump sum. And if your income falls below a certain amt based on family size they have to reduce the bill.

 

[OTE]

Also, again based on your fmaily income, if you think your son would qualify for the state medicaid program for kids only (not the regular medicaid) apply fast. Most of the hospital charity care or programs I mentioned above will help you with the application and also point you to other resources... talk to the hospital billing dept ... and I recommend in person.. if you really need to pay this.

My point being that when you apply for Medicaid, they go back something like 3 mo from that date and cover old bills.

Also based on family income, if you think your son will qualify for SSI (which comes with medicaid) do that application asap... also covers retro bills.

 

[bigblueagain]

sorry I am just now seeing this....but if the hospital did not tell you the insurance company offered to move the patient and also would not negotiate with the insurance company, then in my opinion all you owe is your normal copay. I hope you have dates and names of everyone you have spoken to to back up what has been told. Did you have a precertification requirement with your insurer? If you did and notified them within the required time frame, usually 48 hours after admission excluding weekends which are not considered normal business hours, then you should let the insurance company take it from there. I do imagine the hospital will try to send you to collections so I would stay on the insurance company constantly to get this resolved. Make them send you everything in writing once you get them to intervene. BLUE