I think the hospital is overbilling my insurance... what should I do?

momotheflyinglemur · February 2016

So for my things it seems that all the things billed are in order, but for Odie's stay there is a nearly $1300 bill for his stay in the "nursery". The only thing is he didn't stay in the nursery. He was in a bassinet in my room the entire stay.

Have any of you ladies had to deal with anything like this?

thatgirlree24 · February 2016

I work for health insurance so in cases like that you can call your health insurance company and let them know and they will call the billing dept to find out what they are charging you for that. Usually when you have health insurance, you receive a separate bill for you & baby unless it specifies otherwise. And nursery may mean something else in the "billing world".

Bombmom3 · February 2016

Might be a "padding" fee that they charge all babies whether they are actually utilizing the nursery or not (the staff, bassinets, etc) worth alerting your insurance, though, so they can investigate it further.

momotheflyinglemur · February 2016

Yeah, calling insurance is going to be my first step. We did get separate bills. Everything on mine seems pretty legit, his on the other hand... a little shady. hahaha

Gingermom15 · February 2016

That's pretty steep. Definitely call the insurance company to have them investigate.

Henry's hospital stay totaled less than $200, which included a NICU stay, an echo, two x-Rays and a couple breathing treatments.

momotheflyinglemur · February 2016

@gingermom15 Yes, I expected something much more along that line.

thatgirlree24 · February 2016

From my experience a lot of people don't expect to receive large bills after they have a baby. Unless you have a small ded or no ded chances are, it's going to cost a lot. But again that's my experience working for a health insurance company for large employer groups.

christiel14 · February 2016

Dealing with insurance here too. Last week I combined mine and my son's bills and set up a payment plan. Then today got a notice about when our next payment was due but the bill was $1500 more than last week. Called them up and even the billing people can't figure out why. I hate dealing with insurances. I for one never thought that we would owe almost $5000, especially with having my own insurance plus my husbands as supplemental.

RSB1982 · February 2016

I used to work for a hospital billing department and I'm guessing the 'nursery' charge is what they call the baby's room charge (even if the baby was in the same room as mom). It probably refers to all the staff care given to the baby and the bassinet and other supplies used. If you haven't already, you can call the billing department and ask for an itemized bill and explanation. I know it seems high but I'm guessing this is probably correct. Hospital billing is insane. There is a lot of overhead expense so everything seems outrageous.

FWIW, despite the large bill, insurance companies usually have a pre negotiated case rate they pay on procedures. So even though the bill may be large, they will only pay whatever the contracted rate is for 'normal vaginal birth' or 'c-section', etc. The rest is written off as a contractual adjustment. Then you just receive a bill for your co-insurance and deductible.

amye02 · February 2016

Working on insurance here too, we have a $519 "monitoring fee" buried in Jackson's bill (separate from mine). I'm trying to get them combined for a payment plan now.

taysun · February 2016

Has everyone received a separate bill for baby's stay? I only received one for my stay a few weeks ago. We've even already gotten the bill for the lab work she had done three days after discharge.

TomekiaB · February 2016

Generally medicare and Medicaid will only pay something like 60% of what hospitals bill and private insurance will pay more but base it on this percentage to determine what's reasonable (but rarely all of what is billed), hospitals as a result tend to over bill in an effort to get payments up to a financially sustainable level. If you do get a bill you can typically negotiate if it is a large bill to something reasonable for your income.

LaceyH13 · February 2016

We had a $1500 "nursery" fee too. I guess since I work in insurance regulation I was prepared for it, but if you aren't up to speed on insurance I can see how you would be surprised.

Where I am from it is more common to receive two separate bills (one for mom, one for baby). It wasn't like that until about two years ago, but then it changed.

All of this is the reason I went with a high deductible plan and HSA for the past year. Yes, the deductible is $5,000, but we have no other out of pocket expense so we knew exactly how much we would need to pay. Also I love that the money we use to pay it is tax-free.

ATolentino89 · February 2016

I have a "nursery fee" too. I have stacks of the itemized bills. I added it all up and i think it came out to a grand total of about 20,000 for all of it. Luckily I had a kick ass policy and I will only be paying a total of 2,500 for pregnancy and delivery. Thanks to a payment plan it's $66 for the next 18 months

cedixon2 · February 2016

I about fell over when we got billed for our twins birth. 68,000 and they wanted 1000 a month to pay it off. But we have Tricare and when the collection agent came after us last week I said nope! And then he looked and and oh here's a note that says 0 patient copay.

BellaM110 · February 2016

cedixon2 said:

I about fell over when we got billed for our twins birth. 68,000 and they wanted 1000 a month to pay it off. But we have Tricare and when the collection agent came after us last week I said nope! And then he looked and and oh here's a note that says 0 patient copay.

I I have tricare also. I didn't pay a dime entire pregnancy and have yet to receive any crazy bills for delivery. The only bill I have relieved was for $28 for the pedi visit in the hospital.

do you have prime or standard?

cedixon2 · February 2016

Prime

BellaM110 · February 2016

cedixon2 said:

Prime

Same here! Well hopefully won't get any more crazy bills in the mail!

amye02 · February 2016

Uuuggghhh I just got a notification today that my insurance added the baby incorrectly "coverage effective date 1/1/2016 CIGNA denied all claims" WTF

ammnam14 · February 2016

Did you deliver at an off post hospital without a referral?! 68000 is crazy! I have standard but just got back on prime. My bill was a total of $36 dollars. I unfortunately had surgery while on standard so I'm not looking forward to that bill.

amye02 · February 2016

taysun said:

Has everyone received a separate bill for baby's stay? I only received one for my stay a few weeks ago. We've even already gotten the bill for the lab work she had done three days after discharge.

Jackson was born 12/14 I didn't get anything for him until this past Saturday from the hospital

ATolentino89 · February 2016

I don't miss a whole lot from that life... But I do miss tricare.

katy4128 · February 2016

I also got a nursery charge for Leo. I'm not sure how it is for the hospital you delivered at but where I was at all babies do a hearing test and a blood draw. The only time he was not in the room with me was during the time he was away for those tests and to get circumcised. It was a total of about an hour to an hour and a half max. All of that was what our nursery bill was for. Good Luck!

navyblueladybug · February 2016

I wish I was back in Canada so I wouldn't be dealing with medical bills! DD had to get her metabolic screen done again... The state of Kentucky sent us two certified letters in the mail telling us we had to go get them done again, it was very important, blah, blah, blah. Our pedi said we had to do a more in depth test. Well, we now have a bill for $1000 because of it!!! If it was required by the state, why the hell are we paying for it?! Thank God for insurance because the real bill was almost $5000 before they covered some of the cost. Oh, and 15 mins with the specialist MD cost us $300... And all he did was give us info I could have found looking stuff up on Google! I think DH is going to call the state and ask how we get reimbursed for the tests, bahaha! I know it won't amount to anything but I'd love to hear what they have to say.

pupsicle23 · February 2016

DD was born 12/8 and I got a pedestrian visit bill for her. Actually, it was a sketchy phone call and I said I'll pay it when I get a statement. Still waiting on that.

I did just get a bill for a blood test that my ins said they'd cover when I called and asked. It was a nonessential lab bc DD had a cyst in her brain at her 20 week ultrasound. My insurance ended up denying the claim. Cute.

But anyway, I think it depends on your insurance. I did a cost prediction and it came it to about $2000. The separate billing seems like something that would make sense to the insurance company. DD has her own card and everything, so I can see how they'd bill her services separately.

cedixon2 · February 2016

ammnam14 said:

Did you deliver at an off post hospital without a referral?! 68000 is crazy! I have standard but just got back on prime. My bill was a total of $36 dollars. I unfortunately had surgery while on standard so I'm not looking forward to that bill.

cedixon2 · February 2016

cedixon2 said:

ammnam14 said:

Did you deliver at an off post hospital without a referral?! 68000 is crazy! I have standard but just got back on prime. My bill was a total of $36 dollars. I unfortunately had surgery while on standard so I'm not looking forward to that bill.

It was at a women's health center, approved by Tricare. I'm guessing it was so much because it was twins and I got to experience vaginal and an emergency csection. I haven't seen a bill for all the ultrasounds either from the specialist.

pupsicle23 · March 2016

DD had to have a hip ultrasound at 6 weeks because she was frank breech. I just got a letter saying that my insurance is denying coverage for the $600 bill. Anyone else have to do an ultrasound? Did your insurance cover it?

ColoradoHiker · March 2016

taysun said:

Has everyone received a separate bill for baby's stay? I only received one for my stay a few weeks ago. We've even already gotten the bill for the lab work she had done three days after discharge.

QBF

I asked my insurance about it ahead of time, but Rhys was included under my name/ billing for everything except circumcision. My BCBS said he would have been separately billed only if he had to stay in the hospital after I left.

taysun · March 2016

@ColoradoHiker baby is on BCBS but I'm on tufts so I wonder if there will be some confusion on billing.

LaceyH13 · March 2016

mhuber223 said:

DD had to have a hip ultrasound at 6 weeks because she was frank breech. I just got a letter saying that my insurance is denying coverage for the $600 bill. Anyone else have to do an ultrasound? Did your insurance cover it?

You should be able to appeal that decision. And in my state if they deny the appeal you can get an external review by a third party doctor.

thatgirlree24 · March 2016

They only deny if you weren't covered at that time or if it wasn't medically necessary. Like pp said, you can appeal their decision if they won't reconsider claim.

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