10K Emergency Room Bill - Ins won't pay

[al91206]

What is the name of your state (only U.S. law)? CA

Insurance Company: BlueCross / BlueShield of Florida - paid via COBRA benefits after layoff

I find myself in a situation that a combination of red tape, my procrastination, and LOTS of back and forth created and I'm looking for some advice.

Timeline:

1. I was laid off Oct, 2008 (health ins ended Oct 31st, 2008)
2. I went to emergency room Nov 19th 2008
3. I opted in to COBRA policy Dec 21st 2008 (I had 60 days to make decision)
4. I went to pay bill but my company had changed benefit adminstrators - so I contacted my old company and via back and forth calls, etc it took until May, 2009 to pay the bill and then 2 months after that to get BlueCross / Blue Shield to accept the fact that I was covered
4a) In that time from Nov, 2008 to May 2009 the hospital (St. Joseph's in Burbank, CA) sent me various bills and it went to collections ($10K)
4b) FINALLY - when I got my payment for my insurance paid and BC/BS accepting that I was covered I contacted the collection company to submit bills to BC/BS - this was in late-June 2009
4c) Called BC/BS and wanted to know how long I could submit a claim - they told me 1 year
5) Got a letter from BC/BS saying they weren't going to pay St. Joseph's because it took them too long for them to file the claim. They said they wouldn't allow St. Joseph's to bill me either

A) I would like to know if I could be liable for these charges?
B) I feel bad for St. Joseph's since they gave me great care and I feel like it's not their fault, but obviously I don't want to pay the 10K since this was a comedy of errors and delays.

Any info would be GREATLY appreciated.

Thanks,

Al in SoCal

[cbg]

You not only can be but are, liable for these charges. The hospital was billing you all along; it's not as if they never sent a bill out until after a year. And, for that matter, it's not been a year since November 2008 yet.

You went to the ER on November 19 and you still procrastinated sending in your COBRA elections for another month? WHAT were you thinking?

[al91206]

I understand. A question though is why they told me I have up to a year to file the claim?

While the first part of this issue from Nov to end of Dec was all my fault, the rest of the time from January to June the fault was on my old employer and their benefits administrator. I'm not deflecting blame - I accept that I made poor decisions, but I think since they happily accepted my COBRA payments, shouldn't they pay the bill as well?

Originally Posted by cbg

You not only can be but are, liable for these charges. The hospital was billing you all along; it's not as if they never sent a bill out until after a year. And, for that matter, it's not been a year since November 2008 yet.

You went to the ER on November 19 and you still procrastinated sending in your COBRA elections for another month? WHAT were you thinking?

[cbg]

Your employer and benefits administrator are not the ones responsible for paying the bill. BCBS is responsible for paying it only to the point that it says in the contract.

The person who incurred the service - that's you - is ALWAYS the one with the bottom line responsibility for the bill.

What was stopping you from making payments against the balance of the bill, and accepting reimbursement from the insurer once the coverage got cleared up?

If the plan document says that you have a year to submit the bill and the year is not up yet, then someone needs to bring that to the attention of BCBS. You are free to appeal.

[Zigner]

Originally Posted by cbg

Your employer and benefits administrator are not the ones responsible for paying the bill. BCBS is responsible for paying it only to the point that it says in the contract.

The person who incurred the service - that's you - is ALWAYS the one with the bottom line responsibility for the bill.

What was stopping you from making payments against the balance of the bill, and accepting reimbursement from the insurer once the coverage got cleared up?

If the plan document says that you have a year to submit the bill and the year is not up yet, then someone needs to bring that to the attention of BCBS. You are free to appeal.

If the ER is a plan participant, they may be contractually restricted from recovering from the member.

[ecmst12]

Ok deep breaths everyone.

MOST likely scenario - Hospital bills insurance. Insurance denies for timely filing. HOSPITAL CAN NOT BILL YOU for this denial, like your insurance told you, per their contract with your insurance. Hospital will then APPEAL the timely filing denial because of the extenuating circumstances, and most likely, the appeal will be granted and the claim will be paid.

[al91206]

To all who are reading my post I want to let you know that I understand it's my fault, but there were some extenuating circumstances on my part as well.

I was trying (emphasis) to get my company to pay a month of my benefits as part of my severance package - and it took them 45 days to say no. I didn't want to say yes to cobra - then have my old work say "you already paid".

Also - I was broke so I didn't want to have to wait for reimbursement. Not to mention the fact that I've never had to deal w/ COBRA, so I was new to the whole experience, and I was thoroughly depressed as a result of the layoff.

One last thing - and totally not relevant - in the 3 years I worked at this company I had never been to the emergency room - it's hard to believe that 19 days after I lost my benefits this happened (turned out to be kidney stones).

Thanks for the advice and I really do hope the hospital gets paid via the insurance because I did receive great care there.

Al in SoCal

[cbg]

I'm sorry, but "I wanted my employer to pay my insurance for a month as part of my severance" is NOT an extenuating circumstance that will legally excuse you from paying a bill that you incurred.

I do not agree with ecmst12 that you cannot be billed in the circumstances described, and it is unusual that I disagree with her. But the hospital was billing you all along. If the hospital had never sent a bill to you then I'd be inclined to agree that failure to pay for timely submission was relevant. But that's not what happened.

The smart thing to do would have been to send the bills along to the insurance anyway to get them on record. Even if denied, the insurance carrier would have had them in the system. When the insurance issue was resolved, they could have been reprocessed.

I sincerely hope that the insurance pays the hospital because if it does, they won't send your bill to collection and ruin your credit. But I am still not seeing anything that excuses you from paying.

And there was NO excuse for not signing up for COBRA the day after you made your emergency room trip. That was unbelieveably irresponsible of you.

I say again, if the plan document says you have a year to file and it's not been a year yet, appeal the decision. But prepare to make payment arrangements with the hospital if declined because YOU OWE THEM.

For the record, I have worked for three and a half years for a third party administrator, five years for a national insurance carrier, and more years than I want to count administrating benefits from the employer's side of the desk. I'm not exactly inexperienced.

[ecmst12]

Originally Posted by al91206

5) Got a letter from BC/BS saying they weren't going to pay St. Joseph's because it took them too long for them to file the claim. They said they wouldn't allow St. Joseph's to bill me either.

His insurance company DOES have the power to forbid the hospital from billing the patient in this circumstance, and would not have included that in their letter if they were not exercising the power.

[cbg]

Sorry, but I'm not seeing it. According to the poster they billed regularly. The fact that the insurer did not see the bills for several months is not the hospitals fault but, frankly, that of our poster who was holding out for paid insurance and did not make a timely application for COBRA; then got into difficulties with the administrator. I cannot imagine how that can be construed as a late billing on the hospital's part. And if it can, I likewise cannot see how the poster can be exempted from payment.

What you're telling me is that the hospital can be forced to eat $10,000 worth of charges because of a series of bad judgment calls and administrative screwups that they had no control over and no hand in creating. And I simply don't buy that.

[ecmst12]

Which is why, when the hospital appeals the denial, it will likely be paid.

[al91206]

Finally got resolution to this.

The hospital paid - yes - I'm lucky. The real trip about this entire experience is that the reason I was worried was that the bill was 10K - the insurance paid all of $800 - and that was the bill for them.

I'm happy this was resolved and thanks for the advice.

[xylene]

Originally Posted by cbg

What you're telling me is that the hospital can be forced to eat $10,000 worth of charges because of a series of bad judgment calls and administrative screwups that they had no control over and no hand in creating. And I simply don't buy that.

Well, me of all people are not about to have a big pity party for big health system hospital.

BUT

the complexity of crap like this is all too real for the medical system.

Clients we work for, end up eating a lot more than 10,000 bucks because of byzantine rules and contracts.

The common sense rules that govern health policies, yeah they cut both ways.

[IsabellaSoriano]

Originally Posted by al91206

Finally got resolution to this.

The hospital paid - yes - I'm lucky. The real trip about this entire experience is that the reason I was worried was that the bill was 10K - the insurance paid all of $800 - and that was the bill for them.

I'm happy this was resolved and thanks for the advice.

phew. thanks for the update.