Insurance Question....

gysberger04

I'm sure you all are quite experienced in your insurance policies with the NICU stays, so I'm hoping to get your feedback on this situation.  Our daughter was born in October and had a 37 day NICU stay.  We thought we had received all of our hospital-related bills when we got another one today (well, not a bill, it was a statement from our insurance saying we owe X dollars for something from the hospital stay and to expect the bill from the provider soon).  The "bill" amount includes our deductible for 2012 since insurance processed the bill in 2012, even though the charge was for a service in 2011.  So my question is, am I responsible for paying the 2012 deductible for a service provided in 2011, just because the provider delayed in processing the bill?  (We obviously maxed out our out-of-pocket for 2011 with my and my daughter's hospital stays so we really don't have the extra money to spend on this additional bill).

royalcrown1

My insurance is horrible with procesing bills (they cover a lot of stuff, but process everything wrong.)  I feel like every January/February, I am getting explanation of benefits that are calculated according to the current year, but treatment occurred in the previous year.  When I was pregnant with the twins (daily ultrasounds and NSTs, twice a week ECHOs) and once they were born (2 NICU stays and a PICU stay for heart surgery at 10 weeks), I was on the phone usually 2-3 times a week with insurance.  The point is you can always call if you think that they processed something wrong and things should be processed by treatment date not processing date.

Hope this helps!

gysberger04

Services should be billed by treatment date and NOT by processing date, correct?  This is the main issue I am trying to figure out; obviously I will be calling them today, but wanted to have some knowledge before I went into the phone call.

cookiemonster03

you're correct.

I'll spare you the details, but 90% of our hospital stuff was billed improperly. The girls were born 7/29 and our insurance company has gone from not covering, to covering part, to reprocessing the whole damn thing...which is where we are right now, at 7 mo old tomorrow. I have dozens of EOBs with various totals on them. Its ridiculous.