Double Payment to Hospital

[kcv]

What is the name of your state? Florida

After my son was admitted to the emergency room, my health insurance company erroneously identified the hospital as out of network. They never informed me of their denial and I found out four months later when I received a notice from the hospital threatening to report me to a collection agency. In order to preserve my credit record, I paid the bill myself. I then wrote an appeal to my insurance company, clearly stating that I had paid the bill and instructing them to make payment to me instead of the hospital. The insurance company paid the hospital. When I protested, they claimed they "acted correctly" because I had signed an assignment of benefits upon my son's admittance and did not provide proof of payment in my appeal letter. They said it's up to me to go after the hospital for the money. But I live overseas and that could prove difficult and costly.

Shouldn't my appeal letter instructing them not to pay the hospital have over-ridden the assignment of benefits form? Rather than knowingly make a double payment to the hospital against my (the client's) written instructions, shouldn't the insurance company instead have requested proof of payment from me?

What are my options at this point?What is the name of your state?

 

[cbg]

Shouldn't my appeal letter instructing them not to pay the hospital have over-ridden the assignment of benefits form?

Since you did not provide proof of payment, no.

Rather than knowingly make a double payment to the hospital against my (the client's) written instructions, shouldn't the insurance company instead have requested proof of payment from me?

They did not knowingly provide double payment. All they knew is that you claimed to have made a payment. It was not their responsibility to ask you to provide proof of payment; it was yours to supply it. For all they knew, you hadn't made any payment and were planning on stiffing the hospital.

 

[kcv]

Okay. Help me understand this. I pay the insurance company for their services. As their client, don't they have an obligation to respond to my requests? I specifically told them NOT to make payment on my behalf. Are you saying they can completely disregard that?

 

[cbg]

Yes. You initially signed an assignment of benefits. They have to go by that unless they have been provided with PROOF that payment has already been made. Your "instructions" do not override a legal assignment of benefits unless you can provide proof of payment, which you failed to do.

 

[Zigner]

What are my options at this point?What is the name of your state?

Request/demand reimbursement from the hospital. (Have you even asked them about it?)

 

[kNOwtheLAW]

Something is not quite adding up here. . .

What is the name of your state? Florida
After my son was admitted to the emergency room, my health insurance company erroneously identified the hospital as out of network. They never informed me of their denial and I found out four months later when I received a notice from the hospital threatening to report me to a collection agency.

Generally, they do not deny a claim for treatment by a service provider out-of-network, but pay in accordance with the lower out-of-network schedule.

In order to preserve my credit record, I paid the bill myself.

Okay. . .

I then wrote an appeal to my insurance company, clearly stating that I had paid the bill and instructing them to make payment to me instead of the hospital.

So, based on your appeal they decided to pay your claim as if it was in-network? Wow, that's great!

The insurance company paid the hospital. When I protested, they claimed they "acted correctly" because I had signed an assignment of benefits upon my son's admittance and did not provide proof of payment in my appeal letter.

Upon signing the assignment form they are legally required to forward payment Assignee.

They said it's up to me to go after the hospital for the money. But I live overseas and that could prove difficult and costly.

You really don't have to 'go after' the hospital. If your account has a credit balance I'm sure they'll be very happy to forward the credit balance to you upon request. How much could a phone call or postage stamp cost?

Shouldn't my appeal letter instructing them not to pay the hospital have over-ridden the assignment of benefits form? Rather than knowingly make a double payment to the hospital against my (the client's) written instructions, shouldn't the insurance company instead have requested proof of payment from me?

As you stated, "[you] did not provide [them] proof of payment in [your] appeal letter." The assignment is to ensure the hospital gets paid. In the past, too many "clients" have received insurance benefit checks and 'stiffed' the hospital, hence the need for an assignment of benefit form.

What are my options at this point?

Simply send a 'nice' letter to the hospital asking them to forward your credit balance as, by your calculations, all claims, charges, and service fees have been paid either by you or your insurance carrier. Indeed, if that is the case you will receive a nice check in the mail overseas or wherever you direct them to send the money. If you maintain an account in Florida or U.S., you could ask them to electronically deposit or even 'wire transfer' the funds to that account.

Simple, huh?

KTL