My 92 year old father was sent from the nursing home to the ER in early January with an urinary tract infection that was not responding to treatment. The hospital diagnosed him with Fournier's gangrene and a sepsis infection. The treatment recommended was extensive tissue removal in his groin and thigh. Considering his overall health condition and his wishes previously expressed to me I chose to "make him comfortable" and let him pass. He was transferred to a hospital room, given morphine, and the next morning he was put under hospice care. Two days later he passed away.
He was in an Aetna Medicare Advantage plan. Aetna approved and paid the ambulance and doctors bills but denied the Hospital bill of just over $6,000 stating that "This is not covered. Your stay did not meet the impatient criteria. Your care could be provided without an inpatient stay." They also state "We have denied all or part of this. However, you are not responsible for paying the billed amount because you received this service from an AETNA MEDICARE PLAN (HMO) provider OR based on a referral from an AETNA MEDICARE PLAN (HMO) provider."
Predictably, the hospital sees it differently and is billing us (my father) for the full amount.
I have been in contact with Aetna about this and have a direct phone
number to a contact who actually answers the phone and seems to know what he's doing. He tells me that the hospital is bound by their contract with Aetna and under the contract the claim is denied. The hospital appealed the denial and the denial was upheld. He says the hospital cannot bill the patient for this and he has called the hospital and discussed this with them. He says the hospital can be penalized by Medicare for trying to collect from the patient. However the hospital is continuing to bill me (my father) for this.
I am conflicted on how to handle this. I am sympathetic to the Hospital. They are there when you need them and they need to get paid. The hospitals around here are in bad shape financially and I don't know how its going to get better. On the other hand, they should know what they're doing and they should be able to deal with Aetna and get paid.
So to the point of all this I would appreciate any advice or suggestions on how to handle this. It is the last remaining unfinished business from my fathers death and I would like to have it go away. The latest bill from the Hospital threatens to turn it over to a collection agency. If the hospital would take an amount similar to what they would have gotten from the insurance company I'd pay it just to make it go away. But I'm reluctant to start offering payment amounts as it suggests accepting responsibility.
He was in an Aetna Medicare Advantage plan. Aetna approved and paid the ambulance and doctors bills but denied the Hospital bill of just over $6,000 stating that "This is not covered. Your stay did not meet the impatient criteria. Your care could be provided without an inpatient stay." They also state "We have denied all or part of this. However, you are not responsible for paying the billed amount because you received this service from an AETNA MEDICARE PLAN (HMO) provider OR based on a referral from an AETNA MEDICARE PLAN (HMO) provider."
Predictably, the hospital sees it differently and is billing us (my father) for the full amount.
I have been in contact with Aetna about this and have a direct phone
number to a contact who actually answers the phone and seems to know what he's doing. He tells me that the hospital is bound by their contract with Aetna and under the contract the claim is denied. The hospital appealed the denial and the denial was upheld. He says the hospital cannot bill the patient for this and he has called the hospital and discussed this with them. He says the hospital can be penalized by Medicare for trying to collect from the patient. However the hospital is continuing to bill me (my father) for this.
I am conflicted on how to handle this. I am sympathetic to the Hospital. They are there when you need them and they need to get paid. The hospitals around here are in bad shape financially and I don't know how its going to get better. On the other hand, they should know what they're doing and they should be able to deal with Aetna and get paid.
So to the point of all this I would appreciate any advice or suggestions on how to handle this. It is the last remaining unfinished business from my fathers death and I would like to have it go away. The latest bill from the Hospital threatens to turn it over to a collection agency. If the hospital would take an amount similar to what they would have gotten from the insurance company I'd pay it just to make it go away. But I'm reluctant to start offering payment amounts as it suggests accepting responsibility.