Hospital rebilling after invoice paid.

[jpitas]

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

I just got a bill from for a Hospital stay last November. I was billed for $1100, which I paid in Dec. Last week I received a bill for $431 from the hospital. Looking into it, my HMO said they received an additional bill from the hospital for $2500 which they paid, my portion is the $431. The explanation from the hospital is that they found an error, it wasn't coded correctly, on the original bill to the insurance company. How does this work? I pay a bill for services rendered shortly after the time of service and they can come back whenever they please and say I owe more? My HMO says the policy is written so that they can make adjustments up to 1 yr after the servie is provided, but this seems ridiculous. What happens if I tell them no?

[Wirelessany1]

Originally Posted by jpitas

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

I just got a bill from for a Hospital stay last November. I was billed for $1100, which I paid in Dec. Last week I received a bill for $431 from the hospital. Looking into it, my HMO said they received an additional bill from the hospital for $2500 which they paid, my portion is the $431. The explanation from the hospital is that they found an error, it wasn't coded correctly, on the original bill to the insurance company. How does this work? I pay a bill for services rendered shortly after the time of service and they can come back whenever they please and say I owe more? My HMO says the policy is written so that they can make adjustments up to 1 yr after the servie is provided, but this seems ridiculous. What happens if I tell them no?

There was obviously an error and your HMO paid their part, now it is time to pay yours. If you don't pay, the account will go to collection. If it goes to collection and you still don't paid, you could get sued.

I'm not sure whether you care or not, but if it does go to collection your FICO can take a hit.

[jpitas]

Yeah, so they say....I don't get it...I called the Hospital, they claimed the insurance co pulled back and said they wouldn't cover as much as what they previously claimed. I called the HMO, they said, no, the hospital claimed they found an error and resubmitted the claim to the insurance co, who then paid it. I called the Hospital back and they are claiming when I paid the bill in Dec, that it was just an "installment", not a final bill. I'm sort of on a witch hunt because I'm getting double talk from both the ins co and the hospital, and I don't believe anything that either of them is telling me, so I've requested records from each so I can "help" sort it out. So its a question in my mind if there is a "billing error" or not.
My question is more around when a bill for service can be considered complete. I was billed in Dec, promptly paid the bill. Now they want more money. In addition, the HMO recently changed names which may be an acquisition...the hospital calimed they found the error when reviewing records....I'm suspicious they are looking for cash, and may be reopening previously closed files, and my HMO isn't pushing back as much as they should.

[lealea1005]

Providers AND insurance companies can audit their records and correct claim/billing errors, in some cases, a couple of years past the service date.

The services were provided to you and they deserve their corrected payment.

ETA: Providers have to prove they filed the claims within the timely filing period for the insurance company/