Hospital asked me for permission to appeal any denied claims

[John Galt III]

I haven't had this before. I took my mom to the ER, and somebody had me sign an electronic pad to authorize various things. One of the things was my permission for them to appeal any denied claim.

Why would they need the patient's permission for that?

I have seen many eob's with lots of denied claims, in which the hospital gets zero money from the ins co, and the patient owes zero to the hospital.

In the past was the patient the only entity who could appeal a denied claim?

If patient owes zero on a denied claim, he has no incentive to appeal it, of course.

This is in NJ with a medicare advantage plan.

I am sensing that if I give them permission to appeal, it is going to cost me money somehow. no?

 

[OldShooter]

... I am sensing that if I give them permission to appeal, it is going to cost me money somehow. no?

Why don't you ask them?

 

[John Galt III]

Why don't you ask them?

I asked the hospital if it would be to my advantage to allow them to appeal a claim, and they said 'yes, of course'. I didn't ask why.

I suppose if they were successful with the appeal, I might then owe a copay or coinsurance, whereas if they were denied, I would owe zero.

 

[teej1985]

I asked the hospital if it would be to my advantage to allow them to appeal a claim, and they said 'yes, of course'. I didn't ask why.

I suppose if they were successful with the appeal, I might then owe a copay or coinsurance, whereas if they were denied, I would owe zero.

Owe zero? more like you'd owe everything.

Why would you think you owe zero because the insurer denies the claim? Hospitals don't work for free.

 

[UpQuark]

Owe zero? more like you'd owe everything.
..

+1

I do think you would owe the whole amount. I got billed the entire amount last year for some medical appointments and it was because the doctor's office billed incorrectly so Medicare denied the claims, and by the time the incorrect billing was sorted out, too much time had elapsed since the appointments and the only way to get Medicare to pay was to submit an appeal. I assume the doctor's office did it for me because I didn't get anymore requests to pay the bill.

 

[OldShooter]

I asked the hospital if it would be to my advantage to allow them to appeal a claim, and they said 'yes, of course'. I didn't ask why. ...

WADR you are not going to get to understanding if you roll over and play dead like that. Keep asking "why" until you get a complete answer that you understand. If the call center worker bee and their supervisor can't answer, move on to talk to Accounting or Billing. Or, if they have an ombudsman you may be able to jump the line by going there.

 

[John Galt III]

Owe zero? more like you'd owe everything.

Why would you think you owe zero because the insurer denies the claim? Hospitals don't work for free.

Because on the EOB's I have seen, for a hospital visit, many of the claims were totally denied, hospital got paid nothing, patient paid nothing, and there was a note on the EOB reminding patient that he owed nothing. I've seen that many times.

Usually more than half of the claims were paid, so hospital got some payment.
I guess the ins co is identifying many line items in the claim as frivolous.

I just know what I have seen on the EOB in the past.

 

[MichaelB]

Because on the EOB's I have seen, for a hospital visit, many of the claims were totally denied, hospital got paid nothing, patient paid nothing, and there was a note on the EOB reminding patient that he owed nothing. I've seen that many times.

Usually more than half of the claims were paid, so hospital got some payment.
I guess the ins co is identifying many line items in the claim as frivolous.

I just know what I have seen on the EOB in the past.

Some of those claims were likely the wrong billing code, which were then modified, resubmitted and paid. This is common. A wrong billing code may be an error, or just an attempt at overbilling that was detected and rejected by the insurer.

 

[Jenna]

Signing a parent into a hospital could open you up to liability for their medical bills. After much research, i would not personally sign for an aging parent

 

[RetMD21]

I don't know if they really need permission to appeal but I don't see any harm in signing.