Anyone else have problems with bogus hospital bills?

[NameRedacted]

Sorry this is so long TLR - Hospital billing department is useless.



Here's the situation.


Last year my gf had cardiac rehab (amongst other things) from mid March through early June. She met her max out of pocket for the year. In February of this year we called the insurance company since she actually paid more than the out of pocket max. It took one phone call and was relatively painless and we got a check back from the insurance company for the difference.


In March of this year we got a bill for $70.12 from the hospital. The only explanation was that it was the outstanding balance for cardiac rehab for the month of May. We called in to get more details and just got the runaround. We ended the call with the rep promising to investigate and send us another more detailed bill. A few weeks later we got another bill for the exact same amount with no further explanation.



We called again and got the same lack of co-operation. They couldn't explain what exactly the bill was for and why it was for services that occurred 10 months ago. Again they said they would send us a more detailed bill and again they sent us the exact same bill.


We decided to involve the insurance company, since we had met the out of pocket maximum they would be paying it anyway. The insurance company wouldn't pay the bill unless they knew exactly what it was for.


We did a three way call with the insurance rep and the hospital rep. It lasted about an hour and we just went round in circles. The insurance agent tried really, really hard to get information out of the hospital rep about exact date of service and services provided (my gf had 7 sessions in May) and even provided a complete breakdown of what the insurance company had been billed for so far and what had been paid and what we had paid. The call ended with the hospital rep telling us that we needed to escalate the call and the only way to do that was to transfer us over to a number where we could leave a message to have a specialist call us back.


We never got a call back but we did get a bill for the same amount again.


We called back and talked to a hospital rep who again promised us a detailed breakdown. And Success! We did get a breakdown - although it made no sense.


It has three sections - with lots of lines in each section but summarised as follows:



Hospital Charges: $1474.06
Payments: -$84.58
Hospital Adjustments: -$1261.88
Total Balance: $127.60


Some of the adjustments are positive and some negative but each one just says Adjustment as the line item. There is no explanation as to what each adjustment is. Most of the adjustments were made in June and July of last year but some were made in February of this year.


Also the balance is $127.60 not $70.12.


So we called back and finally got a rep who provided some more information.


The reason for the discrepancy is that we had a credit of $54.48 for May of last year. Even better - we also have credits for March and April of 2018 and so they owe us money!!


So for the last three months the hospital has been trying to bill us - even though they owed us money and 4 separate agents never even mentioned this fact - nor did they contact us to let us know they owed us money.


Upshot is the hospital will send us a check plus I requested a breakdown of the charges AND credits for the months March-May 2018.


I still have no idea how they calculate the charges or adjustments or why we received a credit or why it took them ten months to bill us or why they never mentioned they owed us money.

 

[aja8888]

Sounds pretty typical to me.

It took me three months to get a refund for overpayment of deductible from the hospital. The only way I made it happen was to deny the charge on my CC on the 59th day.

 

[MRG]

I had the pleasure of being on a tour of a large hospital's HIIMS area. There was a few hundred thousand square feet of medical records that, while not lost, weren't in the patient's file.

Our guides did admit that sometimes suspended ceilings fell down from files hidden above them. There's no too much that would surprise me.

 

[Sunset]

Had a problem with the hospital billing us just over $1,000 , it took over a year with phone calls every month (new bill in mail) and 3-way calls, etc.
Hospital even agreed we didn't owe anything, yet bill kept coming.
It finally got resolved, or at least the bill stopped coming.

No wonder medical expenses are so high, it costs them probably 10x what other businesses pay to collect the money, mostly due to incompetence.

 

[trumpeting_angel]

Hah! I just posted why I prefer traditional Medicare plus a supplemental plan over a Medicare Advantage plan. I want to choose my own hospital! And doctor!

It’s not just the billing department, folks.

 

[audreyh1]

I’m still waiting for reimbursement!

 

[Dtail]

Very timely. Got a call from the hospital which I used 4 years ago and they stated they owe me $60, so I agreed and they sent the check. No idea what it relates to in detail.

 

[GalaxyBoy]

DW just had a similar, although less complicated, experience. I let her handle it, but after an hour on the phone after requesting and receiving several iterations of "more detailed" bills over several weeks, the discrepancy had something to do with the provider including either a charge or a credit for a visit that occurred after the date of service of the bill in question. Totally confusing. We were left wondering how many people give up and just pay it.

 

[Clone]

The medical industry is much like the government. If they had to play by the same rules and be transparent like normal industry, they would all be out of business in 6 months. We had a similar go-around over 'unpaid bills' that were sent to collection. We never received a bill, and it turns out the insurance company had kicked it back because it was coded wrong. And it was close to a year after the services had been provided.

 

[jimandthom]

Last July, I had bloodwork done to the tune of 1200 ish. After all was adjusted and paid by the insurer, my bill was 140ish and I paid to the hospital.

In Dec I received a refund from the hospital for the 140.

Last week of May, I received a bill from the hospital for the full original amount of the bill. Dutifully called the hospital billing, seemed to be getting a couple of iffy answers.

Ultimately a supervisor came on and said that Aetna had pulled back the payment last fall and that was the reason for my refund in Dec and the new billing this May.

Called Aetna---who claims that the payment was never pulled back. They called the hospital, while I was on the line. Supposedly the issue is being taken care of.

Way too confusing for me.

 

[ncbill]

Back when mom was sick (diagnosed around age 50) her dementia made her look so much older that the hospital would send her bills to Medicare, even though she didn't live long enough to qualify.

So more than a year later (some cases 2+ years) I'd get hospital and hospital-related bills.

 

[jollystomper]

Not surprising. We have been receiving a quarterly bill for around $100 from a health care provider for almost 2 years now. It happened soon after the health provider we had used for years was purchased by another provider. After multiple calls they could not explain what it is for, they keep saying "this is the last one"... but it is like the cat that came back the very next day. We have even asked for a letter stating that the bill is in error, but they will not send one, just saying "it should be straightened out in the next cycle". Incredible.

 

[neihn]

Reading this thread just makes me sick. I just can't understand why people would bow down and accept these behaviors for so long.

Is there anything that we could do?

 

[Sarah S]

My insurance company and both hospitals I have gone to have websites where I can see the bills and what is happening with them. The free standing mri center I went to had the same.

My pcp and eye doctor do not have thiso I can only see what they submit to the insurance. Whenever possible I would say sign up for patient portals and online billn. You have a much better chance of sorting out these issues in real time. I have had 4 instances of billing errors- all of which I was able to resolve fairly quickly. It is hard for them to argue when you can show them what you did wrong and have it in screenshots from their website

 

[beowulf]

After my mother passed, I had the USPS forward her mail to my address. About 4 months later there were several bills sent to her (forwarded to me) for services performed as well as drugs administered after her death. I called the hospital and told them that the bills were not payable as there were no services performed. They continued to insist that the bills needed to be paid and asked if I would take responsibility. I refused as all her legitimate hospital and doctor bills had been paid by Medicare and her supplemental insurance. This went on over a period of weeks. Finally I asked them if they preferred to contact her directly - clearly I was dealing with mental midgets as they asked for contact info. I gave them her now disconnected home phone number as well as the address for the cemetery without telling them it was one. Never heard from them again. I guess they just had to check a box saying they tried.

 

[FargoI]

In the context of hospitals....
where erroneous bills are received, I recommend disputing the charges in writing with a CC's to the Director of Revenue Cycle ( billing). It's reasonable to anticipate a one to two week delay in receiving a response as this time will likely be invested in researching the matter. " In the event no response is received (following a reasonable period of time) or the response is insufficient/incomplete/inaccurate, a followup correspondence with a copy to the Chief Compliance Officer will likely garner necessary attention. Should attempts to be a reasonable person fail, a letter to your state's attorney general with CC's of all prior billing statements and related correspondence with a CC to the Chief Compliance Office may prove effective. To obtain the names of these hospital officials Google is your best friend. Often people in these positions make presentations in professional forums and their contact information is generally on the last slide of the PPT. If you are not inclined seek out the contact information, call the Hospital's HIPAA Privacy Officer/ official and ask them to kindly provide the information. Most privacy officers will be sufficiently thrilled that you are not reporting a breach concern that they will be willing to assist. Hospital Privacy Officer's contact information is posted prominently in the building, on hard copy HIPAA privacy notices and conspicuously on the hospital's public facing web site. Hopefully you will revive the customer service you deserve and will never need to go the escalation route...if you need to escalate, you have insights into the inner workings of what many refer to as 'complex' healthcare organizations. One last point, my mother told me repeatedly that you catch more flies with honey- it's not unusual for front line billing staff to be inundated with complaints all day long - from frustrated, exasperated, sick or injured people...a good dose of kindness and some gentle humor might be all that's needed.


FargoI

 

[Scrapr]

When Mrs Scrapr was dealing with Cancer the bills came very fast. The first cancer Dx was at the end of a policy year. So about March we go into member services and ask how much do we owe? Simple right? We'd just like to see a breakdown of charges by date and write a check. We had asked out at the check in folks if they had a number. they gave us 2 figures before telling us to go to member services.

The MS woman could not do a report of outstanding amounts by date. She said did you look at your explanation of benefits? And we are like do you know how many of those come in a week. Sometimes 3 a day. There is really not a way to track them while at the same time dealing with a serious disease

we just paid the lowest amount that anyone said. The following 2 years we hit OOP max early in the year so it was relatively simple

 

[blueskyk]

With all the talk (and obfuscation - new favorite word) on healthcare, I wish we could get a lot more transparency on costs and billing. For years, I managed an extensive medical situation for DH and as if that wasn’t challenging enough, had to research and resolve discrepancies when I was billed knowing the deductible had been met in, oh, the first six minutes of each year for about three years in a row.

My favorite was a row between the provider and insurance company with the insurance company insisting all balances had been paid and the provider insisting a balance was due. The discrepancy, which I ultimately discovered, was accumulated gross receipts tax over about 18 months. Looks like a clever person at the insurance company figured you could reduce reimbursements with no reduction in benefits by paying for the services but not the tax.

This was all some time ago but painful enough that I recall seriously considering a side hustle as some sort of patient billing advocate because people in complex and expensive medical situations could use some love on this front.

 

[frayne]

Sounds pretty typical to me.

+1, happens at least once a year in my household.

 

[ivinsfan]

This is just wrong on so many levels..

DH had 2 open heart procedures first one private insurance with deductible , second one Medicare with supplement.

First time around massive piles of paperwork and online EOB...now it was pretty stressful because post surgery they discovered an ongoing probable genetic heart issue that required different treatment. Random bills come in from labs, the gas passers ( I think they these print the bills in the OR they show up so quickly)…

I followed along paid what I thought I needed too and when the bill finally showed up from the hospital added what they said we owed to what we had already paid. Pretty much right on the money for our OOP deductible. I never heard another word from anyone so I guess it was good. But it was all such a blur, now you guys have me wondering if I paid something I shouldn't have. Oh well.

This time around statements from Medicare but not one bill and haven't paid one penny OOP for surgery number two. So it's irritating to see two premiums every month for our supplements, I remind myself I didn't spend one second thinking about who needed to get paid what and how much.

 

[scrabbler1]

This one ended well, but not without some bumps along the way.


Back in July of 2015, I was in the hospital for 12 days. It took several months for the insurance company and hospital to work out their differences. I had received an EOB which showed only what the hospital was charging but without any payments or bill reduction yet. About a month later, I got a letter from the hospital telling me what I would probably owe, as it did reflect a preliminary reduction.


Soon after that, the insurance company mailed me a large check which I was to turn over to the hospital (it was out-of-network but I was still covered because it stemmed from an ER visit where I was admitted). I also got a revised EOB which was consistent with the earlier hospital letter, a good sin. I drove to the hospital nearby so I could personally handle the payment with the cashier.


The IC and hospital were still haggling over some small, remaining charges, I was told by someone else in the billing department, so my share of the final amount might not be what was in the earlier letter.


In December, the IC and hospital worked out their differences. I still owed some money for my copay and coinsurance, along with a state tax on hospital bill, as a bill from the hospital stated. However, the hospital bill showed a higher amount due than either the revised EOB or their earlier letter.


After calling the billing department, I drove to there a week or so later and showed them all the relevant paperwork. The billing lady agreed with me that the higher billed amount was wrong and I paid the amount due, less an 10% early payment discount (and just before the end of 2015 so I could deduct it on my 2015 income taxes). She wasn't able to give me a receipt at the time, but I saw her write in her records and on copies of what I gave her that the balance was paid in full.


End of story? Not quite.


In early 2017, more than a year later, I get a letter from a collections agency telling me that the hospital has turned my delinquent account over to them and I owe several hundred dollars more. I pull my 2015 records out and compare the account number to the one in the letter and they match. I try to figure out if the hospital s trying to (balance) bill me for the excess amount I successfully argued back in late 2015 which didn't belong. Or maybe the 10% early payment discount was considered a balance due now. Nothing matched or was close.


I call the collections agency and explain to them that I was paid up. Expecting a rude response, I was pleased at their civility. I told them I would call the hospital's billing department and try to straighten it out. They agreed my account was paid in full with a zero balance and would tell the collections agency to withdraw their claim on me.


A few days later, I called the collections people back and they told me the hospital had already called them to cancel my alleged outstanding balance and for me to ignore their collections letter. I was somewhat stunned but pleased. Heard nothing more from either party.


Still, a nuisance.

 

[Texas Proud]

A hospital is very good at taking your money but very bad at giving it back...


When my DW had very minor surgery they insisted I pay my 'share' before they would even let her in... after many months I get the EOB from insurance and I overpaid by hundreds of dollars... so I call the hospital to find out where my money was!!! Guess what? I was told the person I need to talk to just left for maternity leave and would not be back for 2 months...


YES, they were not planning on sending anybody back any money for 2 months!!! There was nothing I could do but wait....

 

[beowulf]

That's when you start sending emails to your local TV news.

 

[braumeister]

This is all reminding me of my favorite adventure in bad billing, although it was long before the internet.

I got a bill for $0.00 due to a (primitive) computer system apparently having a hiccup while processing my payment.

I laughed and ignored it. But the same bill kept coming, month after month, "30 days past due," "60 days past due," "90 days past due," and my phone calls were just ignored. "Don't worry about it," they said. "It's obviously a mistake," they said.

Eventually, the threats became more and more earnest, and one day I got a certified letter in the mail telling me that they were going to turn the matter over to a collection agency if the bill was not paid in full within the next 30 days.

Being in the military at the time, that was a very serious matter for me, so I did the only thing possible. I wrote them a check for $0.00 and mailed it in, certified mail, return receipt.

That did the trick, and the bills finally stopped. The check was never cashed, for some unknown reason.

 

[Potstickers]

My MIL managed to create a heck of a mess with doctors, hospitals and pharmacies.
1. She was covered by insurance company A (primary) through her retiree plan + insurance company B (FIL's retiree health plan) + Medicare.
2. Her retiree plan dropped insurance company A and offered instead choice of insurance company C (an HMO) or D, with the HMO being the default if you didn't send in an election for company D.
3. She ignored several letters from her retirement plan and kept using her insurance company A card when visiting doctors, hospitals and pharmacies...and A kept paying for four months after the plan had ended!
4. Eventually, insurance company A woke up to the reality that they had months of expenses they should not have covered, and sent a demand letter. Meanwhile, MIL had been assigned to an HMO across Los Angeles from where she lived, and they weren't paying for all of the out-of-network expenses she'd incurred for four months.
5. Insurer B didn't want to pay since all the prior EOB's maintained that A had paid.

After a long call with a helpful and sympathetic rep at the retiree health plans center, MIL was enrolled in an appropriate fee-for-service plan backdated to the beginning of the year, and we got a several-inch-thick stack of EOBs reprocessed for various providers...which then had to be dealt with office by office. Apparently MIL wasn't the only person who'd done something like this. I felt bad for all the billing folks who had to try and unravel the mess she'd made.