health insurance / hospital bill advice needed

olp920

In september 2012 I went to the emergency room a week and a half before I had my son. I had issues relating to pregnancy, but nothing to be on the labor and delivery floor for. I paid for my copay in the ER (was probably $100) and later on paid the remainder of the bill that came to my house (I believe it was just short of $200). About a year later I started getting bills in the mail for that visit. I called the hospital and explained that I already paid, but they insisted that the insurance company 'changed their minds' and adjusted the bill - and now I am being held responsible for the difference, which is $236. I called the insurance company and they say the same thing.

Is this legal? I have let this go on too long, I know. It is going to ruin my credit score if I don't just pay this bill, but I feel like it can't be legal and they are harassing me. I don't know if I would take any kind of legal action to prove the bill is paid, but $200 is not just change to me. Any advice here? Or and I just wrong and this sort of thing happens all the time?

Whenigrowup

I've never heard of this happening, but I don't know how much you can do about it.  I would do like pp suggested and find your EOB from the visit, and any other documentation you may still have.  A phone call might at least get you more of an explanation.

I'm a bit jaded when it comes to medical bills, and TBH I would just be thankful that it was "only" #200 ish dollars.  That amount of money is significant to me, too, but when you're talking hospital/emergency room, it could be much worse.

Whenigrowup

Obviously meant $ instead of #.  Leaving it because lazy.

ToastieSimons

1) medical bills can't go on your credit report

2) they can take you to collections and get a required payment, but again, doesn't affect your credit

3)  You need to get your EOB from the visit

4) You also need to call your insurance company and ask WHY they changed their mind

Most insurances have a clause that if they deem that the visit wasn't ER required they will require you pay for the visit.  However, it seems the insurance companies are automatically deeming ER visits as non-emergent no matter what.  I had to file 3 appeals to get my insurance company to pay my ER visits when I was pregnant (norovirus and 3 rounds of IV fluids and medications)

5) Worst case scenario you have to pay the hospital bill.  You can then file appeals with your insurance company to get reimbursed. You can also call the hospital and tell them you are filing appeals and fighting with the insurance company.  Some will put your account on hold and not require a payment for 6 months.

Lolapop29

Medical bills do effect your credit. I had thousands of dollars of medical debt from when I had cancer and my credit went down the toilet. 

Call the hospital and set up a payment plan, they wont send it to collections if you are making some kind of payment every month even if it's only $10 a month.  

olp920

Thank you for all the feedback. I have had medical bills that hurt my credit before. They were paid, but we had to go through hell to prove they were paid in order to get approved for a mortgage. I do like the idea of paying and then appealing... I'm so dumb when it comes to any type of insurance.

BootsOrHearts

Yes unfortunately the insurance company can change their mind at any time. However, call them and ask for an explanation. It could be they made a mistake such as assuming you have some other insurance or that it was a work accident, something like that. Even if the adjustment is valid, ask them if the difference is your responsibility or the hospitals to eat. Hospitals are assholes sometimes about trying to get you to pay what they lost because of their contract with insurance.

BootsOrHearts

twolittledogs said:

Also, I got a bill from the pathology office 2 months after they provided a a service that went directly through my insurance. My EOB said I owed $0, but that office still sent a bill which was the difference between what they billed me for and was insurance was contracted for. I called the path office and they removed the barge immediately. That was shady, in my opinion.

That's the kind of thing I'm talking about. They will say 'oh sorry it's a mistake' but you wonder. In many states there are anti-fraud laws and there are federal laws too so you can report it.

tealowl

The $100 you paid sounds like your copay. The other amount is more than likely your COINSURANCE or DEDUCTIBLE, which are amounts that you are required to cover before your insurance pays their portion.

Or, if it was not your first ER visit this year, your insurance company may pay less (mine does this, I would owe more everytime I utilized the ER in a year).

Or, that hospital may not accept your insurance and not have a contract rate with them, so your insurance paid less and you get charged a non covered rate.

You need you EOB from that date to make sure it matches your hospital bill. Sounds like you already got that verified by your insurance company, though.

It's not illegal for your insurance company to re-adjust a claim that they may have overpaid.

Yes, medical bills CAN go to collections and CAN disrupt your credit score.

I would first work out approved payment arrangments with the hospital if you cannot pay in full. You can't just randomly send in $10/mo if they didn't approve it, they can absolutely send your bill to collections for non approved too small of payments (no hospital wants a charge on their A/R forever).

If the charge went to collections, normally a good collection agency will work with you on payment arrangments before reporting to credit bureaus.

Hope that helps!

 

Sincerly, Your Neighborhood Medical Biller =]

tealowl

BootsOrHearts said:

Also, I got a bill from the pathology office 2 months after they provided a a service that went directly through my insurance. My EOB said I owed $0, but that office still sent a bill which was the difference between what they billed me for and was insurance was contracted for. I called the path office and they removed the barge immediately. That was shady, in my opinion.

That's the kind of thing I'm talking about. They will say 'oh sorry it's a mistake' but you wonder. In many states there are anti-fraud laws and there are federal laws too so you can report it.

That's normally human error, not fraud. They apologized and fixed your bill. It's happens. It's happened before at the office I work at. Someone didn't read the EOB correctly, and we billed wrong. Either the patient catches it, or we catch it when we review accounts. If a patient paid it, we send them a refund.