Hospital billing nightmare

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LiterallyIronic
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Hospital billing nightmare

Post by LiterallyIronic » Sun Mar 26, 2017 8:13 pm

Okay, so I'm running into a nightmare situation with billing after we had our baby. Yes, we have health insurance. Yes, we have maternity coverage. Too bad that did nothing for us.

Here's the billing situation:

My wife's individual deductible is $7,500. Her maternity deductible is also $7,500.

So far, we have paid $5,284.53. I could itemize out every cent, but the meat of it was pre-paying the doctor $3,500 for the delivery and pre-paying the hospital $500 during registration. The rest is a bunch of tests and ultra sounds.

After the delivery, we now get a bill for the baby of $5,705.63. Of that, $4,686.60 is for "nursery", even though we kept the baby in our room the whole time, barring a few tests (and weigh-ins) that were done in the nursery (however, we were billed separately for those). So that's rough. $4,700 for seemingly nothing.

And we get a bill for my wife of $3,940.09. The bulk of this is $2,854.61 for the C-Section (and $644.90 for the anesthesia).

Problem number 1:

I'm getting billed $2,854.61 for the delivery, despite the fact that I already pre-paid what was originally estimated to be $3,500. Shouldn't I be getting about $700 back instead? Or, at a minimum, shouldn't the bill show the $3,500 credit?

Problem number 2:

I also pre-paid the hospital $500 during the registration. Yet I don't see this $500 credit anywhere on the various bills.

For those problems, the answer is going to be "go to the hospital and talk to them." Sure, I'll do that on Monday at 6am when they open. Which is really the only time they're open that not during times that I'm at work. So that will be fun. /s

Problem number 3:

We have two separate insurance plans. My wife is on one, and I have my own. We added the baby to my plan. The hospital apparently assumed that the baby would be on my wife's plan. Hence, the bill that shows my wife's charge of $3,940.09 also includes the "denied" bill of $5,705.63 due to lack of coverage for the baby.

Problem number 4:

My wife's insurance account is showing that we've paid virtually zero towards her deductibles. About $450 towards her individual deductible of $7,500 and about $90 towards her maternity deductible of $7,500. Despite the fact that I've been paying out the nose.

Now, we specifically kept that insurance because of the maternity deductible. In case it was a crazy $100,000 NICU bill or something. However, it seems like whatever we pay it doesn't even go towards our deductibles. Or even towards our bills because we seemingly got nothing for the $3,500 and $500 pre-payments.

Possible solutions

The things to do with certainty are get the hospital to credit us the $3,500 and $500 that we've already paid.

But after that, there are some options.

A) We have the impending $5,705.63 bill. The hospital tried (and failed) to go through insurance for it, because they tried to apply it to a plan that our baby isn't on. The hospital will usually grant a pretty serious discount (in the vicinity of 30-40%) for people who are paying in cash instead of through insurance. We could theoretically approach the hospital and ask them for the cash discount and hopefully pay less than the $5,700 they're trying to collect. However, I'm not even sure we owe that money to the hospital or to the insurance company who may have already paid the hospital and then tried (and failed) to collect from us?

B) Tell the hospital to apply the baby's $5,705.63 bill to the right insurance. Theoretically, that might get us a lower price, going through insurance. But, maybe it won't and then we'll be out the entire $5,705.63 instead of the potentially cheaper price as a cash payer. The flip side of this is that the $5,705.63 would apply toward the deductible on my plan and therefore if there were anything else major this year, we'd hit the deductible and pay less. That is, if they even apply it toward the deductible, since it seems nothing does.

C) My wife's insurance allows new babies to be added to the plan up to 31 days after birth to be retroactive to the birth date. Tomorrow is day 30. I could feasibly put the baby on my wife's plan. Then, theoretically, all that would be applied to those deductibles and we might pay less. The family deductible is $15,000 though, so we still wouldn't hit it. The deductible on my family plan is $9,000. But putting the baby on my wife's plan costs $30/month more in premiums than it does to add the baby to my plan. Hence we might still end up paying every cent of these bills without hitting the deductibles and just end up owing $30/month more in premiums.

All said and done, the current bills add up to $14,718.83 for everything related to having this baby. And here I thought there was no way we'd pay more than $7,500 because that was the maternity deductible that we'd be paying premiums for. Of course, if we can get our credits of $3,500 and $500, then that brings the bills down to $10,718.83, but still. And that doesn't include all the monthly premiums we've paid.

I'm not sure what to do. What I am sure of is that health insurance is pretty much pointless, because it didn't do jack for us.

D) With this bill being $3,000 - $7,000 higher than expected, this is going to make a serious dent in our house down payment fund. I'm considering temporarily stopping our $1,000/month retirement contributions so we can get back on track to buying a house in a reasonable time frame. I'm also considering getting a part time job to do a few evenings per week, but 9 hours per week at $10/hour really won't do much for us.

Any thoughts?

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in_reality
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Re: Hospital billing nightmare

Post by in_reality » Sun Mar 26, 2017 8:29 pm

LiterallyIronic wrote:
Any thoughts?
Congratulations on the the little one!!! And remember the pain of this billing is nothing compared to what your wife's been through!!! Bless her heart!!!
Last edited by in_reality on Sun Mar 26, 2017 8:30 pm, edited 1 time in total.

BruDude
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Re: Hospital billing nightmare

Post by BruDude » Sun Mar 26, 2017 8:30 pm

Is this not an ACA-compliant plan? How does she have a $7500 deductible and separate $7500 maternity deductible?

The baby's expenses for the first 48-72 hours after birth should be covered under the mothers deductible too.

drawpoker
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Re: Hospital billing nightmare

Post by drawpoker » Sun Mar 26, 2017 8:35 pm

Wow, what a mess to have to deal with. Especially during a time when you and your wife should be enjoying this special event in your lives. Without having this hassle.

Can't help with you with any of this insurance mess - except to say this -

It caught my eye when you wrote your wife had a C-section. The standard of care (in all good hospitals, anyway)
is that a pediatrician must be standing by (either in the O.R. during the surgery or right outside the door) at the time the OB doc orders a section.
(Reason for this rule - if anything should go wrong and the baby is born in distress - an OB cannot provide care)
So, perhaps the some added charges you weren't expecting involve the services of the pediatrician who had to be on standby, along with the associated "nursery" charges the hospital is billing you for.
Last edited by drawpoker on Sun Mar 26, 2017 8:36 pm, edited 1 time in total.

LiterallyIronic
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Re: Hospital billing nightmare

Post by LiterallyIronic » Sun Mar 26, 2017 8:36 pm

BruDude wrote:Is this not an ACA-compliant plan? How does she have a $7500 deductible and separate $7500 maternity deductible?

The baby's expenses for the first 48-72 hours after birth should be covered under the mothers deductible too.
It's a "grandmothered" plan, whatever that means. I thought all the hospital expenses would be covered under the mother's deductible, which is specifically why we held on to the plan instead of going with the cheaper (but no maternity coverage) option through my work. But exactly zero of the baby's expenses have been applied to my wife's plan. Possibly because the baby didn't get added to her plan but mine instead?

radiowave
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Re: Hospital billing nightmare

Post by radiowave » Sun Mar 26, 2017 8:36 pm

The Nursery charge is actually the room and board part of the bill (accommodation component of the billing which is about 50% of costs of delivering care). Interestingly all of the nurses who you interacted with are billed under the room and board charge so don't take the nursery charge literally.
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LiterallyIronic
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Re: Hospital billing nightmare

Post by LiterallyIronic » Sun Mar 26, 2017 8:38 pm

drawpoker wrote: It caught my eye when you wrote your wife had a C-section. The standard of care (in all good hospitals, anyway)
is that a pediatrician must be standing by (either in the O.R. during the surgery or right outside the door) at the time the OB doc orders a section.
(Reason for this rule - if anything should go wrong and the baby is born in distress - an OB cannot provide care)
So, perhaps the some added charges you weren't expecting involve the services of the pediatrician who had to be on standby, along with the associated "nursery" charges the hospital is billing you for.
We have a C-section charge of the aforementioned $2,854.61, but there is also another C-section charge allocated to a different doctor for $230. I believe that is the pediatrician.

stan1
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Re: Hospital billing nightmare

Post by stan1 » Sun Mar 26, 2017 8:43 pm

By grandmothered do you mean a plan she had purchased prior to ACA taking effect and exercised the "if you like your current plan you can keep it" option?

My advice: pull an all nighter reading every last piece of information you can find about the two plans and make sure you fully understand the choice. The hospital won't be able to make the decision for you whether to put the baby on your policy or your wives and it sounds like you have a very short timeline. Or put the baby on both if you don't have the information to make a decision you are confident in.

Once that decision is made the rest they can correct in their systems. Don't spend your time in the next few days worrying about retirement savings or getting a part time job.
Last edited by stan1 on Sun Mar 26, 2017 8:48 pm, edited 2 times in total.

HIinvestor
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Re: Hospital billing nightmare

Post by HIinvestor » Sun Mar 26, 2017 8:44 pm

For the $30/month more, it might be worth having baby in BOTH insurance plans so baby is dually enrolled and get better coverage. You can always drop baby from coverage but can only add during qualifying event.

I'd talk with your HR person at work about the medical insurance and see if they have someone that can help you. Try to get name and contact info of people at hospital, the OB/GYN, Pediatrician, your insurance and W's insurance, and ask where you are being credited for amounts you already paid and where it shows payments are being applied against the deductible.

Sorry this hassle is jarring the joy and adding stress to your life as a new dad. Congrats!
Last edited by HIinvestor on Sun Mar 26, 2017 8:46 pm, edited 1 time in total.

LiterallyIronic
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Re: Hospital billing nightmare

Post by LiterallyIronic » Sun Mar 26, 2017 8:46 pm

in_reality wrote:
LiterallyIronic wrote:
Any thoughts?
Congratulations on the the little one!!! And remember the pain of this billing is nothing compared to what your wife's been through!!! Bless her heart!!!
Thank you. And yes, I feel bad for her. She had her whole delivery planned out on what pushing positions she was going to use, and breathing techniques, and what-have-you, but then complication required us to do an immediate C-section. Scariest minutes of my life. :(

drawpoker
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Re: Hospital billing nightmare

Post by drawpoker » Sun Mar 26, 2017 8:54 pm

LiterallyIronic wrote:
We have a C-section charge of the aforementioned $2,854.61, but there is also another C-section charge allocated to a different doctor for $230. I believe that is the pediatrician.[/quote]

Probably not. At that price, sounds more like the fee for whomever performed the Apgar test(s) Which must be done twice - 1 minute after the birth and then again 5 minutes later

Keep digging.

LiterallyIronic
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Re: Hospital billing nightmare

Post by LiterallyIronic » Sun Mar 26, 2017 9:00 pm

HIinvestor wrote:For the $30/month more, it might be worth having baby in BOTH insurance plans so baby is dually enrolled and get better coverage. You can always drop baby from coverage but can only add during qualifying event.
It would actually be $70/month more. It cost $40/month to add the baby to my plan; it would cost $70/month to add the baby to her plan.

LiterallyIronic
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Re: Hospital billing nightmare

Post by LiterallyIronic » Sun Mar 26, 2017 9:05 pm

stan1 wrote:By grandmothered do you mean a plan she had purchased prior to ACA taking effect and exercised the "if you like your current plan you can keep it" option?

My advice: pull an all nighter reading every last piece of information you can find about the two plans and make sure you fully understand the choice. The hospital won't be able to make the decision for you whether to put the baby on your policy or your wives and it sounds like you have a very short timeline. Or put the baby on both if you don't have the information to make a decision you are confident in.

Once that decision is made the rest they can correct in their systems. Don't spend your time in the next few days worrying about retirement savings or getting a part time job.
I think grandmothered means something like that. I think we can keep it until 2018.

You make a good point. I have some .pdf files about the plans. The gist of what I know is that her plan would have a $15,000 family deductible and mine would have a $9,000 family deductible. Beyond that, I thought I knew how insurance worked, but since we've spent thousands and haven't made a dent in the deductible, obviously I don't know what I'm doing.

ThankYouJack
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Re: Hospital billing nightmare

Post by ThankYouJack » Sun Mar 26, 2017 9:09 pm

I just skimmed the post, but thought I'd share from a similar experience.

We had a huge billing headache with our hospital. They mis-billed us, we new they did and it took forever to figure out how it happened, prove it and get it corrected. If you're in the same situation, I would:

1) Contact your insurance company and have them go through it with you. Our insurance company is a lot more competent than our hospital billing. Insurance realized the problem too and resolved it with the hospital for us.

2) Connect with the hospital complaints department (I forget the exact name)

Good luck! I'd try not to sweat it that much (easier said than done) and enjoy your time with the little one! :sharebeer

Beensabu
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Re: Hospital billing nightmare

Post by Beensabu » Sun Mar 26, 2017 9:17 pm

I know with my plan, the deductible resets Jan 1st. If yours has reset recently, then anything you paid for the prior deductible year won't apply to your current deductible. Definitely go line by line over your bill with both insurance and hospital billing. Track down the prepaid amounts. Mistakes happen.
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LiterallyIronic
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Re: Hospital billing nightmare

Post by LiterallyIronic » Sun Mar 26, 2017 9:28 pm

Beensabu wrote:I know with my plan, the deductible resets Jan 1st. If yours has reset recently, then anything you paid for the prior deductible year won't apply to your current deductible. Definitely go line by line over your bill with both insurance and hospital billing. Track down the prepaid amounts. Mistakes happen.
Yeah, it reset on January 1st. The ultrasounds, for example, should be applied to the 2016 deductible. All things related to the actual delivery and post-delivery, should be applied to the 2017 deductible. I'm told that includes the $3,500 pre-payment despite us paying in December 2016 for a service that would be rendered in February 2017.

Nate79
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Re: Hospital billing nightmare

Post by Nate79 » Sun Mar 26, 2017 9:48 pm

Confirm with your insurance whether you need to file a claim when you made the pre-payment. My insurance documents hint that this is the case.

Rupert
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Re: Hospital billing nightmare

Post by Rupert » Mon Mar 27, 2017 8:55 am

Were there two ObGyn's present? There often are for a C-section. If so, that would explain the unexpected bill for the delivery. I would expect the pediatrician to bill separately. There will also likely be a separate bill from an anesthesiologist.

LiterallyIronic
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Re: Hospital billing nightmare

Post by LiterallyIronic » Mon Mar 27, 2017 9:13 am

Rupert wrote:Were there two ObGyn's present? There often are for a C-section. If so, that would explain the unexpected bill for the delivery. I would expect the pediatrician to bill separately. There will also likely be a separate bill from an anesthesiologist.
I'm not sure how many OB/GYN's were present. There were a number of doctors and/or nurses (I have no idea who was who) during the delivery. We got a separate bill for the anesthesiologist: $644.90.

Rupert
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Re: Hospital billing nightmare

Post by Rupert » Mon Mar 27, 2017 9:18 am

LiterallyIronic wrote:
Rupert wrote:Were there two ObGyn's present? There often are for a C-section. If so, that would explain the unexpected bill for the delivery. I would expect the pediatrician to bill separately. There will also likely be a separate bill from an anesthesiologist.
I'm not sure how many OB/GYN's were present. There were a number of doctors and/or nurses (I have no idea who was who) during the delivery. We got a separate bill for the anesthesiologist: $644.90.
If there were two doctors working on your wife, then there were two OB/GYNs. The pediatrician would have been standing out of the way waiting for the baby, and the anesthesiologist probably would have been standing somewhere around your wife's head. When my twins were delivered by c-section, the maternity deductible that we prepaid only covered the cost of prenatal services and the delivery fee charged by the primary OB/GYN. The second surgeon, even though she practiced in the same group as the primary OB/GYN, billed separately for the delivery. You don't prepay that doctor because it isn't known until the time of delivery that the second surgeon will be needed. Edited to note that we were warned about the second surgeon's fee up front; in our initial meeting with the practice's insurance person, she told us that there would be a second bill from a doctor in the practice if a c-section was necessary.

sawhorse
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Re: Hospital billing nightmare

Post by sawhorse » Wed Mar 29, 2017 3:53 pm

Ask for a completely detailed list of all charges. Every single CPT code they entered. They may resist giving this to you because they are notorious for having mistakes, sometimes deliberately so I suspect, but insist on it.

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Pajamas
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Re: Hospital billing nightmare

Post by Pajamas » Wed Mar 29, 2017 4:18 pm

The baby is covered under the mother's coverage for the first thirty days automatically.

You should call the hospital billing department and give them the updated health coverage billing information. Also let them know that you were not given credit for your prepayments and ask them to apply those credits. You should not have to go in person. If the hospital's billing service and the physicians' billing service(s) are different, you will have to contact both.

You can also question the nursery charges if the baby did not board in the nursery. However, it is likely that the same services were provided if your baby stayed in the room with your wife and the charges will stand. You could also question any itemized charges for items or services not actually provided. I have seen instances where certain supplies were automatically applied to all inpatient bills or even for charges for supplies to be applied randomly to patients' bills simply by taking a coded sticker off an item and putting it on a patient's card or scanning a sticker with a laser wand.

Don't make any further payments to either the hospital or physicians until after you health coverage has paid their share of the claims and they have credited your prepayments, both.

If you enroll your baby under both your and your wife's health coverage, the primary payor should be your coverage if your birthday is earlier in the year than your wife's, or her coverage if her birthday comes first. You might not see any benefit to having the baby covered under both plans because of deductibles.

If you have trouble with the billing departments, contact the hospital patient advocate and ask for assistance since the problem seems to be on that end.

DireWolf
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Re: Hospital billing nightmare

Post by DireWolf » Wed Mar 29, 2017 6:33 pm

If it's any consolation, you got by very cheap for the anesthesiologist. We charge a minimum of $1,500.

OnTrack2020
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Re: Hospital billing nightmare

Post by OnTrack2020 » Wed Mar 29, 2017 7:24 pm

For problem #1 and problem #2: Did the bill come through with the insurance payment/adjustment applied? For one of our doctors, our payment will not show up on the bill until the insurance payment comes through and is posted. So if I pre-pay toward the bill, my payment won't show up. I have to wait until the insurance pays, then the payment shows up. It's kind of strange, but that is how their billing system works.

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tinscale
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Re: Hospital billing nightmare

Post by tinscale » Wed Mar 29, 2017 7:57 pm

Sorry you're having this trouble. Can't help on the insurance part. Quick googling says $15,000 is in the ballpark for costs of having a baby by c-section.

On the possible part-time job thing, I can tell you that not many retail places will hire someone for only 9-10 hours a week. Most will want your availability to be more like 20 hours minimum.

Good luck.

OnTrack2020
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Re: Hospital billing nightmare

Post by OnTrack2020 » Wed Mar 29, 2017 8:27 pm

Problem #3. You will need to let the hospital know that the baby is on your insurance plan so they can bill to the correct insurance.

OnTrack2020
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Re: Hospital billing nightmare

Post by OnTrack2020 » Wed Mar 29, 2017 8:34 pm

After reading through it all, I think you are going to need to wait until everything goes through---meaning you will need to wait until all the insurance comes through and is posted, along with any adjustments. Sometimes it can take a while. If you added the baby to your insurance, you will want to make sure that those charges come through on your insurance. As for the pre-payments, those I'm thinking will show up once all the insurance payments are processed.

Congrats on your new little one!

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