wrong parent's health insurance company billed for hospital bills for their child's h

[drockhold]

What is the name of your state?

Ohio

This is a long, sad story--


Please help----my sister got a divorce from her husband in 1992---her divorce decree read that her health insurance company at work was to pay for all of their childrens' hospital bills as necessary (minus deductables and co-pays)and her ex-husband's (he lives out of state now) current healthcare provider was to pay as secondary provider at his work.

Her son fell ill in late 1998 with rheumatic fever and serious complications from the illness, and was treated at a local hospital in Lima, Ohio---he was then referred from the local hospital to a childrens hospital in Columbus ohio and was fully treated after 4 months and then released.

Then in late 2000 my sister started receiving collection notices from both hospitals in the amount of $18,000--and found out that they were never paid by her health insurance at work.

After investigation by her, she found out that her insurance company at work was never billed for these charges and that her ex-husbands health insurance company was billed instead of hers as was described in her divorce decree. Her ex-husbands healthcare provider naturally didn't pay these bills.

Now, today after 2 yaers of calling & writing letters to Aetna (her employers past health insurance company) she was told that her employer had switched healthcare providers in 2001 and she was told by Aetna that they didn't have to pay any of her child's hospital bills for his 1998 illness.

She then was instructed by Aetna to submit these past bills to her husbands employer sponsored healthplan for the company he was with in 1998-1999 (Fed-ex)--(health care provider was and is United Healthcare)--although he is with a different company now--(outside of his original employer group in 98-99) Now they won't pay for it because her husband is under another plan with UHC but, with another company.

So, because of their marital situation, and her husband lives 2500 miles away---it looks like she's left holding the bag for someone's clerical error--probably somebody at the Lima, ohio hospital's billing department.

With that all said---can't she go back to the original health provider (hers) and present bills from 1998 --and explain the clerical error that she did not make, and force them to pay the bill for her child?

Or at least go back upon her ex-husbands health care provider for payment (assuming all co-pays and deductables are then subtracted from the balance and get these bills paid?

my point is this---IF the correct healthcare provider had been billed in the first place by the hospital-assuming the origianl error was on the Lima, Ohio hospitals part-then this situation would have never had to happen.

What does she do now?

Help-Help-Help

 

[CIAA]

drockhold,

Your sister may want to seek help from an attorney or insurance claims consultant. It is difficult to say how successful this might be because of your sister's failure to act for some 4-5 years now. You say that she was unaware until 2000 about $18,000 in unpaid medical bills from 98/99 ? It is more likely that she was aware but just let it get passed her. Your sister was responsible for seeing to it that all claims were properly filed and processed. Even now, 3 years after she started working on the "error" it doesn't sound as if she has taken affirmative action, as all we know is that what she has been "told" sounds like the runaround and that a good deal of information seems to be missing.

If the claims had been properly submitted your sister should have received a written determination from each insurance company setting out the specific reasons for the claim denial, including the policy provisions on which the denial was based, along with notice that she could file an appeal. Bottom line is that each company should pay for any covered claims incurred while their coverage was in force. The extent to which the companies can deny on "late notice" of claim or your sister's failure to timely appeal the denial is something that would have to be researched and is dependent on many factors