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Billing Recourse Questions
Old 08-13-2014, 08:31 AM   #1
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Billing Recourse Questions

On Feb 8, 2012, I went to the emergency room in our local hospital for a worrisome injury to my elbow. Yesterday, I received a bill (see below) for $140.

The treatment was covered by Medicare, and my supplemental insurance policy. Since the incident occurred over two and a half years ago, I no longer have a copy of the original billing, but am positive that we received no outstanding bill in the months after the accident. Having been embroiled in a hospital billing dispute over 25 years ago... along with a threat to my credit standing, we no longer let any overdue bill stand, knowing what can happen when a bill has been turned over for collection.

So, here are the questions:
1. For what period of time can the billing department require payment, even though there have been no interim bills.
2. How long should we have to keep copies of billing?
3. Should I choose not to pay, how can I challenge the bill, to avoid having it show up on my credit report?
4. If I should need emergency services in the future, can the hospital refuse treatment?
5. If my doctor is affiliated with the hospital, and I require hospitalization for non-emergency services, can the hospital refuse to accept me as a patient?
6. In this, and many cases where we go to a business for services, there is usually a paper that we have to sign, agreeing to submit to binding arbitration for any disputes. I have understood that the cost of this arbitration may go into many thousands of dollars. Certainly not worth it for low value dollar amounts such as this.
7. Can I require a record of previous billings for the same admission.

In the past, dealing with the same hospital, and receiving a bill before our supplemental insurance claim was received by the hospital... (two months), I questioned the billing office as to the length of time before they would turn the bill over for collection. In that case, a tough talking billing manager told me that it was their business, and their choice.

While I am reasonably sure that I will pay the bill... simply to avoid the angst, I feel that I have no choice... no alternative. At the same time, I worry that something like this could happen in the future, where the amount could be more, and any binding arbitration could go against me and in favor of the battery of lawyers that the hospital maintains.

Could this happen to you? What would you do?
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Old 08-13-2014, 09:41 AM   #2
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This is more common than you think. My guess is the hospital has been actively trying to collect from Medicare over the entire period, they got a "final no" and now bill you.

It's not possible to tell from the statement if you are liable or not, you need a detailed breakdown and also need to know what your insurance refused to pay. It could be an legitimate item Medicare doesn't cover (in which case you pay), it also might be a charge Medicare does cover but declined to pay in this case, in which case you shouldn't have to pay.
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Old 08-13-2014, 09:58 AM   #3
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Is there a 12 month period after which it's not the patients issue? I had always thought that, but I'm frequently mistaken.


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Old 08-13-2014, 11:09 AM   #4
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+1 with what Michael said. You need to get details on the bill and what Medicare and your Medigap policy paid and understand what they didn't pay and why before knowing whether the charges are legit.

First step would be to call the provider and nicely ask where the hell they have been for the last two years since you have never received a bill until just recently. Second, you'll need to decide how much your time is worth to you and whether it is worth the time and effort to protest $140. Providers commonly settle for less so you may be best off to propose that since it is so long ago and it would be a hassle for you to chase down the details that they discount it down to $70 and you'll pay it on the spot and save yourself a lot of hassle.

But if you decide to contest it, but assertive and don't give up. I'm not sure what kind of Medigap policy you have but the ones my mom, grandmother and aunt have/had generally covered everything. In fact, in my aunt's case there is a bill that we keep getting occasionally and ignore because I have notified them numerous times that they have been paid by insurance (I can see where the insurance company paid the claim) but they keep trying to collect it nonetheless. Auntie died over a year ago and her estate has been settled so there isn't much bad that can happen if thye ding her credit score.
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Old 08-13-2014, 11:20 AM   #5
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I got a medical bill years later once. An in network doctor tried to balance bill me for charges not covered by insurance. I knew I did not really owe the money since he was an in network doctor. I sent a letter back explaining why I would not pay and if they tried to ding my credit, rather than pay them I would report them to the insurance company as well as hire an attorney and sue them for damages and attorney fees.

I never got a response, they never sent another bill nor dinged my credit. I think some places just send out letters like that hoping a certain percent of people will pay the bills without question and they leave the rest alone.
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Old 08-13-2014, 12:24 PM   #6
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Similar issue. Sort of. DW and I got extensive immunizations at Health Dept. 11 years ago, HI paid ~$800 and we paid ~$300 as copay at the time. Cool.

Two years later Health Dept bills us for the $800! I raised Hell and they said the HI company had refused payment, in writing. I spent a lot of time with HI company and they had to kick open storage files and gave me a letter that the HD had in fact .... never billed them. So then I directed my wrath at the HD, who admitted they had converted a computer system over and had "difficulties" with it. OK. In the end, it turns out their system had not billed HI, they knew it, and they were trying to put the arm on me since Hi wouldn't accept the claim at that time.

On another issue, we got a bill for $150 from anesthesiologist for colonoscopy. After I paid it, realized it should have been covered as preventative care. HI company backed me up, but I had to extract the $ from the firm. Don't ask me why or what the explanation was, but it triggered billing from them for $150! After several phone calls and 3-4 months finally got my check. I'll never assume I owe a billed medical service again!
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Old 08-14-2014, 09:08 AM   #7
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Since you have supplemental insurance, contact that insurance company with the bill that you have been sent. What the hospital can bill will depend on the type of coverage you have and the type of contract (if any) that they have with the provider. If this is an in-network situation, then there's a good chance your insurer will advise the hospital that they have been paid at their contracted rate and can't send you an additional bill. That would be if this isn't a deductible or copay amount (which the insurer can help answer). Definitely, start with your supplemental insurer, rather than the hospital or Medicare. They'll have the details of the billing, the outstanding amounts (if any), and likely a contract with the provider that can enforce what they can bill to you.
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Old 08-14-2014, 09:32 AM   #8
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My copies of the payments always inform me whether and how much I owe the doctor anything after payment by Medicare and my workplace plan (FEHB).
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Old 08-16-2014, 05:22 PM   #9
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Outcome...

After working myself up to a frenzy with plans of how I was going to handle the situation... I made the call to the billing department. Auto reply.. "This is Janice... I'm on vacation until next week..."
Back to the hospital switchboard... Next number..."I'm out of the office... leave leave your name, telephone number and account number..." Received the beep for message ending in 12 seconds... smoke coming out of ears... called back for administrator.
Now, I'm slightly irritated. He'll call me back...!!!
I'm ready! Ready to talk law... going to go to binding arbitration... will sue..!!!

I was out when the administrator called back... Darn. DW took the call. Administrator took a look at the account... Hmmm... don't know why you received a bill. I'll write it off. Sorry for the trouble.

All that angst... all those plans for retribution and legal action...
WASTED!!!!!!

Enrolling in anger management course on Monday.
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Old 08-16-2014, 05:27 PM   #10
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Quote:
Originally Posted by imoldernu View Post
Outcome...

After working myself up to a frenzy with plans of how I was going to handle the situation... I made the call to the billing department. Auto reply.. "This is Janice... I'm on vacation until next week..."
Back to the hospital switchboard... Next number..."I'm out of the office... leave leave your name, telephone number and account number..." Received the beep for message ending in 12 seconds... smoke coming out of ears... called back for administrator.
Now, I'm slightly irritated. He'll call me back...!!!
I'm ready! Ready to talk law... going to go to binding arbitration... will sue..!!!

I was out when the administrator called back... Darn. DW took the call. Administrator took a look at the account... Hmmm... don't know why you received a bill. I'll write it off. Sorry for the trouble.

All that angst... all those plans for retribution and legal action...
WASTED!!!!!!

Enrolling in anger management course on Monday.
So glad to hear that the issue is resolved. This thread may serve as some help for another who may receive a really old medical bill.
Relax and enjoy the day now that this is off your to do list.
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Old 08-16-2014, 05:32 PM   #11
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Quote:
Originally Posted by imoldernu View Post
All that angst... all those plans for retribution and legal action...
WASTED!!!!!!
Yeah, I hate it too when that happens.
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