Insurance problem

[jchipka]

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

I had a C-section in 2007 and just got a bill a year later in Nov. 2008, the hospital billed me for C-section and 2 epidurals. The insurance picked up part of the epidurals (since the anesthesiologist was not in my network they only paid part), My insurance Used the incorrect CPT code and indicated there were 3 epidurals - no C-Section. I have called and called both insurance and the hospital and no one gets my message - I have given both bills and insurance benefit sheet and now the hospital has sent it to collections, because the collection agency now says "this bill is over a year old". I never received a bill and thought it was taken care of. I have insurance so had no reason to question if this was paid or not.... now, I cannot get anyone to give me information. Was the hospital at fault and gave the insurance the incorrect CPT code or was the insurance at fault - did they use the incorrect code. No one will help me and this bill is over $3K. thank you

[ecmst12]

Don't double post.

If the hospital billed incorrectly, then they have to fix the bill and resubmit it.

[jchipka]

I asked for a copy from the hospital for form UB92 which shows what they submitted to insurance company. They told me I could not have it - This is part of my medical records, am I not entitled to those records? Also, the insurance company is telling me now that the hospital "double billed" me for the same procedure C-Section, one to me under one CPT code and another to the insurance company under another code. Now, if I ask the hospital (can I?) to resubmit this bill because they in fact never submitted the C-section with the code they told me was on my bill, and becasue this procedure is 18 months old, the insurance says it will be TOO LATE to submit for the insurance to pay. How can I resolve this other than getting an attorne? Thanks.

[lkc15507]

Originally Posted by jchipka

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

I had a C-section in 2007 and just got a bill a year later in Nov. 2008, the hospital billed me for C-section and 2 epidurals. The insurance picked up part of the epidurals (since the anesthesiologist was not in my network they only paid part), My insurance Used the incorrect CPT code and indicated there were 3 epidurals - no C-Section. I have called and called both insurance and the hospital and no one gets my message - I have given both bills and insurance benefit sheet and now the hospital has sent it to collections, because the collection agency now says "this bill is over a year old". I never received a bill and thought it was taken care of. I have insurance so had no reason to question if this was paid or not.... now, I cannot get anyone to give me information. Was the hospital at fault and gave the insurance the incorrect CPT code or was the insurance at fault - did they use the incorrect code. No one will help me and this bill is over $3K. thank you

Wow, lots. But let's start with "my insurance used the incorrect CPT". Nope, I doubt that. Insurance does not code the UB. The provider does. Insurer will pay according to how CPT's ICD9's are provided on the UB and or HCSFA's. So, something else is amiss with the discrepancy of epidurals and c-sections. I understand the angst, but when did you begin to protest? Was that within the appeal period allowed by your insurer? Not receiving a bill does not relieve you of the debt. "I have insurance so had no reason to queston if this was paid or not...." is the absolute biggest problem you have. YES, YOU DID have a reason to question. Insurance is not your blind savior. EACH AND EVERY TIME YOU USE YOUR HEALTH CARE PLAN YOU ARE RESPONSIBLE THAT IT IS UTILIZED APPROPIATELY AND APPROPRIATE PAYMENTS MADE. If not, your plan has an appeal procedure.

Okay, it's unfair. We the uneducated on CPT ICD9 HCFA UB92 teminology cannot be expected to know what the hell is going on. But, you can be expected to read your EOB (explanation of benefits form) and then question it if it does not appear correct with regard to patient responsibility. Seems to me as though you did not do that. lkc15507

[lkc15507]

Also, my reply to this post does not contradict my reply to your other question. If you have incurred unreasonable charges because you had no network provider available, that is a basis of an appeal. But, if you stuck your head in the sand beyond the appeal period because you were not reading your EOB's, then I suppose you are SOL even if you had a reason to appeal in the first place. lkc15507