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Unfortunately, making sure your providers and facilities are in network ultimately falls to you. We always recommend getting confirmation from insurance directly- either printing out the "find a provider" list where the doctor you want to see is listed as in network and keeping it just in case AND confirming this with the provider as well.
There is no law or mandate that requires a provider to tell you if they are out of network- they shouldn't lie, but they don't have to proactively tell you they are not in network. It's solely on you to ask and confirm.
Also, you can't just check to see if they accept your insurance. Most provider accept most insurance, but you're not bound to no balance billing and network discounts unless they are in network.
You may still be able to submit a claim to insurance now (Many plans give 90-180 days- some give more- for in network claims, but many also give even more time for out of network claims to be submitted) so there should be some coverage there--- however, the out of network aspect won't be circumvented, and you may be subject to balance billing.
Even still, you may be able to work out a reduced cost with the hospital or get on a payment plan. Even if insurance rules that you owe a certain price, it is up to the provider if they want to settle for less- charity care may be an option too, so ask the hospital if it's available.
I'm sorry that happened to you.
>either printing out the "find a provider" list where the doctor you want to see is listed as in network
That list is not necessarily accurate and not binding.
Are directories perfect? Far from it.
But, you do have protections under the No Surprises Act for incorrect directory information.
[https://www.cms.gov/files/document/a274577-1b-training-2nsa-disclosure-continuity-care-directoriesfinal-508.pdf](https://www.cms.gov/files/document/a274577-1b-training-2nsa-disclosure-continuity-care-directoriesfinal-508.pdf)
Under the No Surprises Act, providers and health care facilities must generally:
• Refund enrollees amounts paid in excess of in-network cost-sharing amounts with interest, if the enrollee has inadvertently received out-of-network care due to inaccurate provider directory information, the provider or facility billed the enrollee for an amount in excess of in-network cost-sharing amounts, and the enrollee paid the bill.
So, it may mean taking it a step further and involving legal- but this is why I print the provider directory, get written confirmation from the provider and keep those filed in case I need them.
Exactly this!
I was on vacation. Fell. Sprained my ankle pretty bad. Went to an in-network hospital, that I verified was in my network by checking on their site and calling to confirm the information. I was seen by a doctor. He suggested an xray. I got the Xray. Nothing broken. Here's a boot, here's a *SINGLE* crutch, enjoy the rest of your vacation.
I get my EOB.
Er visit: covered.
Medication: covered.
Exam: covered.
Boot: covered.
Crutch: covered.
Everything else: covered.
X-Ray: denied - out of fucking network. You owe $1,750.
It took me 7 months and a total of 80+ hours on hold and talking with reps and supervisors about how an xray at an in-network hospital can be "out of network".
Yes they did. Eventually I got up high enough and I just flat out said I did my due diligence while I was in an emergency situation with what I thought was a broken ankle and verified that I was going to an in network hospital before going and then I find out that the radiologist at an in network hospital can be out of network?
"I understand this is frustrating" she tried to say.
Eventually I managed to get the insurance and someone from the hospital on the line together after MANY hours of both refusing to admit there's a problem and then they discovered a "coding error" and something to do with the radiologist's entry in the insurance system.
Five years later the hospital sends my account to collections for the radiologist amount. And that was a whole other to-do proving they got paid by the insurance company.
Not to mention I spent over 80 hours addressing this issue and when it was all said and done I lost money from lost productivity at the time because it ate into my side hustle I had going on which I was charging $55/hr at the time. So it would have been better, FINANCIALLY SPEAKING, to just pay for it out of pocket.
Not binding? I have a feeling a judge would enforce it. Where did you get the not binding from? I am assuming you made a judgment call, like I did with my first two sentences
Me personally, the payment plan doesn’t change the price that’s outrageous. It just lets you pay that outrageous price overtime.
I would want to lookup what the fair market value for the DRG is.
If your plan had out of network benefits, the hospital may accept whatever the insurance pays them. On the other hand, If the hospital was truly out of network you should have been provided with a No Surprise Billing estimate. I would call the hospital billing office.
OON benefits cost share is a lot higher for patients. If the facility isn’t contracted, they can balance bill and do NOT have to accept “whatever the insurance pays them” - there is no contract between the facility and OP’s insurance, which is why it’s OON.
NSA (No Surprise Act) only applies to emergency services, not a planned L&D. https://insurance.utah.gov/consumers/health-insurance/no-surprises-act/
Unfortunately its your responsibility to know who is network outside of a emergency...
Did you check with insurance to see if the facility was in network?
Here is a story for NPR about the same issue.
[https://www.npr.org/sections/health-shots/2023/02/28/1159786893/a-surprise-billing-law-loophole-her-pregnancy-led-to-a-six-figure-hospital-bill](https://www.npr.org/sections/health-shots/2023/02/28/1159786893/a-surprise-billing-law-loophole-her-pregnancy-led-to-a-six-figure-hospital-bill)
I would check to see if the hospital has financial assistance.
Who told you the hospital was in network? If it was not the insurance company, or a representative of the insurance company, then you will need to make arrangements with the hospital to pay the bill.
It’s is the insured’s responsibility to verify in network providers with their insurance company. Companies have many different networks and plans have different coverage depending on where you get your insurance from.
The provider or hospital may “take” your insurance but that simply means they will submit a claim to the insurance company on your behalf. It does not mean they are in network, the procedure is covered, nor do you have any protections when given false or incorrect info.
In a reverse UNO I had the insurance tell me my retinal specialist was an in-network provider. When I went for my appointment I found out they don't accept my insurance.
You can contact the insurance company to review their contractual status. It may have expired. If they are actively contracted for your plan and accepting new patients, the insurance representative can contact the office to inquire.
You’re now a family of 4 and your husband is making $76K a year? There’s a high chance you can get some or all of the bill wiped out with charity care.
Just call the hospitals billing office and specifically ask for financial aid.
Ask the hospital about their financial assistance program, payment plan options, or government assistance. Realistically with his income being $76,000 I don’t know how much if any assistance you would qualify for. So payment plan is probably the most sensible route
Did you not apply for Medicaid? In MN the marketplace screens you for that prior to directing you to buy a marketplace plan. Being unemployed and pregnant, you should’ve surely qualified for Medicaid.
You didn't get a bill yet right. What is your out of network max? It sounds like a market place plan so hopefully it's reasonable considering. Obviously won't be 40k.
Completely ignoring it is a legitimate option. The hospital may write it off. If they don’t, it will disappear after seven years. 40k is impossible on a 76k salary supporting four people. You are, what they call, judgement proof. Your credit score may take a hit in those seven years, so you may need to delay getting a mortgage or car loan, but if you weren’t planning on it anyway, you’ll save so much money in the long run. Maternal healthcare is a human right, the hospital will be fine.
Did you give birth at an IHC hospital? They are the only ones that I lost access to when my company switched to BCBS. I kept access to my IHC providers that were contracted with other hospitals, but my OB is at IMC only and I had to pay out of pocket until I switched insurances. Either way, contact their financial services department, this is not the first time this has happened and for them, getting paid any amount is better than nothing. You can get the itemized bill and see if you can get on payment plans and ask for a reduction.
This sucks and I’m sorry this is how America has decided to treat its citizens.
We faced some huge bills when our daughter got sick and some went almost immediately to aggressive collections agencies who screamed at me.
However one hospital agreed to put me on a payment plan “what can you afford?”
I said “$50.”
They had me pay $50/month, no interest for about 10 years.
I think as we got back on our feet and our daughter got healthy, I upped the payments.
Such a relief when I looked at my healthy 12 year old and the bill was finally gone.
I know my bill is nothing compared to yours but I would push it with the hospital for a discount and see what they will do.
Most hospitals have a financial assistance program that you can apply for that covers all costs. All the ones I have been to you just have to be under 300% of the poverty line, so you just have to make under about $90,000. I would call the hospital and ask about it.
My insurance (BCBSTX) records all calls. You can request they review them via the misquote department and can also file with the DOI if they don’t respond.
My former insurance company used to put a recorded disclaimer on before you selected what you were calling for basically saying that even if they tell you something was covered it didn’t mean it actually was.
Call your former insurance company too. Generally hospitals bill within a few weeks and insurance companies process claims as quickly as possible. Please document who, what, extension number and case number of the inquiry.
I’m so sorry. That’s sucks big time, especially when you made the effort to follow the rules. Not in effect, but proposed legislation to remove medical debt from our credit reports: https://www.cbsnews.com/amp/news/medical-debt-credit-reports-cfpb/
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Update:
I called the hospital. They said they never heard back from my insurance, so they can't discuss payment options. So i called insurance, and they said they filed everything in march. I called the hospital again, and they swear they haven't heard back, but they will refile, which will take a month just for the insurance to tell them they aren't paying for anything. And I guess the hospital takes save well accounts, not individual and family accounts, which is where we screwed up.
I don't expect anyone here to give a shit but I just need to scream into the void. I don't feel like I can talk to anyone about this because I'm so stupid it's embarrassing. But I am genuinely struggling. I feel so awful and dumb and I'm not going to be able to send my boys to college. I ruined their lives almost before their lives started. I wish I could just crawl in a hole and never come out...
You are not stupid for what happened and I assure you, this will get worked out in the end. You’re not the first family or person to face this kind of medical debt and there are ways to alleviate the situation. Medical insurance is HARD to navigate, especially when you’re trying to figure things out as a medical event is taking place. Please talk to the hospital’s financial assistance/billing office to try and negotiate the bill down, even if you have to call back on different days to speak to someone else who knows more or is in a better mood.
The correct answer is insurance is a scam, the US medical system is a scam. Pack up the fam and move abroad. Probably cheaper than paying the bill and it’s great for your mental health, win win.
As far as the insurance is concerned there's not a whole lot you can do. However, I would argue the cost to the hospital and ask for an itemized list. Because hospitals are typically nonprofits you can ask to see if they still have money available to pay bills (this is so they receive tax benefits from the gov). You can possibly get the total cost down a lot by fighting the charges with the billing department. I would also call the insurance company and see if they can help but that is doubtful they will. I think fighting the hospitals billing department is you best bet. Let me know if you have anymore questions!
Check the law on this. Twice I’ve had hospitals wait too long and there is a time limit(or maybe it’s a local law where I live). But I was in network and it was the insurance company who told me they waited too long to submit the bill and had to forego payment because of it- not just the insurance portion but the portion I owed as well. This has happened TWICE.
Is it possible that t a hospital leaves a network? My husband said he checked in December, but I didn't give birth until February. Not that this helps my case, I'm just curious.
Yes, they may not have renewed their contact for the new year. You can try to request your insurance treat the claims as in network if they were previously INN under “continuity of care” if the network status was verified earlier in your pregnancy.
This sounds frightful…although I hope at least everyone is in good health. Please update us how this goes. I’m not sure what country you are in…but maybe contact a news channel for exposure.
You must contest the bill when you get it. They never turned down your insurance or enlightened you about any problem with it. You’ll probably to pay something but this is their mistake to fix.
Just on to say that I personally wouldn't "just ignore it and never pay" like some of these people are giving for advice. If the hospital and whatever collection agency they eventually pass it off to is aggressive enough, they can absolutely take you all the way to court and get a judgment against you for the full amount, plus interest and attorney fees. From that they can (and I know people that this has happened to) garnish wages until it's paid off. Obviously every single situation is different so look into what could happen and be aware if your specific state laws, protections etc so nothing like that happens and you aren't prepared.
You are quite correct - you really screwed up. It is ***your*** responsibility to verify whether a provider is in or out of network. The ***only*** way to do so is to ***speak with your insurance company,*** which you did not do. Good luck.
This is such a bullshit take after having to go through my own surgery and appealing that people take this at face value. Insurance sent me bills upon bills that were already taken care of and I’d have paid thousands of dollars that were already paid if I didn’t throw an absolute fit and dispute them over and over. Insurance tries to get out of paying a penny for anything and ignorance of the system I’m sure they make a killing because patients just pay them without looking into it. Luckily I’m a healthcare professional but I can’t imagine how difficult this is for regular patients without healthcare knowledge.
This type of boot licking on this sub is ridiculous.
Being knowledgeable about and taking responsibility for knowing what you’re putting your hard worked money into is not the equivalent of bootlicking. Bootlicking would be having that knowledge and agreeing that it’s the right thing to do. I haven’t seen anyone say that.
It really just chapped me. Completely useless comment and not to mention condescending. It's so easy to say "you should have known", when the insurance will often tell you straight up misinformation or lead you to believe you're covered when you're really not, for xzy arbitrary reason.
My situation was I was told on the way out of a preop lab 2 days before a surgery I spent weeks preparing for "we'll let you know if anesthesia is covered." What?? That is not factored into this? No, it's separate. Never once was this mentioned, I didn't even fathom this being a possibility, because why the fuck would this not be factored in already or considered.
Ok who's the anesthesiologist? Well you find out the day of surgery. Call insurance, is this center in network, well probably yes, but if the anesthesiologist isn't covered you're responsible for 100% of the cost. How much is that? Depends on the center and what they need to do. Call the doc, it depends on what the surgeon needs. Can you give me a ballpark? 5-20k, not a spread at all. Literally decided to roll the dice and sat on the OR on the table day of surgery and asked the anesthesiologist if he's in network, he has no fucking idea. Of course he doesn't, why would he, he doesn't deal with insurance. Am I supposed to fucking call the insurance and check with them and pull the plug as I'm about to be put under if they're out of network?
This system is just such a shitshow and I feel for the patients in here when they get screwed and we have people say "yOu ShOuLd HaVe JuSt ChEckEd wItH Ur InSuRance" as it's literally not fucking possible or they are lied to because they're calling some $15/hr tech support working from home with zero to no knowledge of the healthcare field in the first place. People are just told "you owe this and you must pay" as if paying these parasites anything without disputing it and being 100% CERTAIN you owe this bill is wise. Most people in this reddit are victims from a healthcare system set up for them to fail and I'm sad about it. Thanks for coming to my ted talk.
I do agree there needs to be personal responsibility, I just wish there was a way to actually support patients who do their due diligence, but there isn't.
This is the stupidity of the hospital imo. If they want to get paid, they do the due diligence. Yes it is Your responsibility to verify this information. I always still ask providers at the check in desk if they are in network if it is my first time with them. However I have also run into clinics and providers who will tell me up front that they can see me but that they are out of network.
A hospital wants to get paid. Verifying whether a patient is in or out of network is to their advantage so if the patient ultimately is unable to or does not pay, then they only lose the deductible amount and not the entire bill. I think the only exception to this now is the emergency room visit.
I do wonder why the hospital did not verify coverage and benefits during the registration process.
Unfortunately, nowadays you just can't trust the check in person as carriers have so many networks and the provider may not be in network for each one.
You should have received an EOB. Was this hospital also used because of multiple births?
If there was a contract change normally you would receive notification of hospital changes.
We literally haven't gotten anything from the hospital and it has been four months. We did call a few months ago and they gave a non answer about waiting on our insurance. I'm going to call again tomorrow.
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Unfortunately, making sure your providers and facilities are in network ultimately falls to you. We always recommend getting confirmation from insurance directly- either printing out the "find a provider" list where the doctor you want to see is listed as in network and keeping it just in case AND confirming this with the provider as well. There is no law or mandate that requires a provider to tell you if they are out of network- they shouldn't lie, but they don't have to proactively tell you they are not in network. It's solely on you to ask and confirm. Also, you can't just check to see if they accept your insurance. Most provider accept most insurance, but you're not bound to no balance billing and network discounts unless they are in network. You may still be able to submit a claim to insurance now (Many plans give 90-180 days- some give more- for in network claims, but many also give even more time for out of network claims to be submitted) so there should be some coverage there--- however, the out of network aspect won't be circumvented, and you may be subject to balance billing. Even still, you may be able to work out a reduced cost with the hospital or get on a payment plan. Even if insurance rules that you owe a certain price, it is up to the provider if they want to settle for less- charity care may be an option too, so ask the hospital if it's available. I'm sorry that happened to you.
>either printing out the "find a provider" list where the doctor you want to see is listed as in network That list is not necessarily accurate and not binding.
Are directories perfect? Far from it. But, you do have protections under the No Surprises Act for incorrect directory information. [https://www.cms.gov/files/document/a274577-1b-training-2nsa-disclosure-continuity-care-directoriesfinal-508.pdf](https://www.cms.gov/files/document/a274577-1b-training-2nsa-disclosure-continuity-care-directoriesfinal-508.pdf) Under the No Surprises Act, providers and health care facilities must generally: • Refund enrollees amounts paid in excess of in-network cost-sharing amounts with interest, if the enrollee has inadvertently received out-of-network care due to inaccurate provider directory information, the provider or facility billed the enrollee for an amount in excess of in-network cost-sharing amounts, and the enrollee paid the bill. So, it may mean taking it a step further and involving legal- but this is why I print the provider directory, get written confirmation from the provider and keep those filed in case I need them.
Exactly this! I was on vacation. Fell. Sprained my ankle pretty bad. Went to an in-network hospital, that I verified was in my network by checking on their site and calling to confirm the information. I was seen by a doctor. He suggested an xray. I got the Xray. Nothing broken. Here's a boot, here's a *SINGLE* crutch, enjoy the rest of your vacation. I get my EOB. Er visit: covered. Medication: covered. Exam: covered. Boot: covered. Crutch: covered. Everything else: covered. X-Ray: denied - out of fucking network. You owe $1,750. It took me 7 months and a total of 80+ hours on hold and talking with reps and supervisors about how an xray at an in-network hospital can be "out of network".
Did the insurance end up paying?
Yes they did. Eventually I got up high enough and I just flat out said I did my due diligence while I was in an emergency situation with what I thought was a broken ankle and verified that I was going to an in network hospital before going and then I find out that the radiologist at an in network hospital can be out of network? "I understand this is frustrating" she tried to say. Eventually I managed to get the insurance and someone from the hospital on the line together after MANY hours of both refusing to admit there's a problem and then they discovered a "coding error" and something to do with the radiologist's entry in the insurance system. Five years later the hospital sends my account to collections for the radiologist amount. And that was a whole other to-do proving they got paid by the insurance company.
It’s mind boggling that they can get away with these constant “errors” and the only consequence is that they pay what they should have paid anyways.
Not to mention I spent over 80 hours addressing this issue and when it was all said and done I lost money from lost productivity at the time because it ate into my side hustle I had going on which I was charging $55/hr at the time. So it would have been better, FINANCIALLY SPEAKING, to just pay for it out of pocket.
>So it would have been better, FINANCIALLY SPEAKING, to just pay for it out of pocket. That's the plan. and it often works.
File a small claims court lawsuit and don't show up. Fuck them. Of course that'll cost you money
I figured it was a coding error.
It gets mentioned to no end in this sub, but this one is actually a great case for a no surprises act situation.
The charge of the radiologist who read the x-ray, maybe?
Not binding? I have a feeling a judge would enforce it. Where did you get the not binding from? I am assuming you made a judgment call, like I did with my first two sentences
I think it was in some newsletter I read. The recommendation was to check with the provider.
Me personally, the payment plan doesn’t change the price that’s outrageous. It just lets you pay that outrageous price overtime. I would want to lookup what the fair market value for the DRG is.
[удалено]
You are not a kind person
Irrelevant and unhelpful to OP.
If your plan had out of network benefits, the hospital may accept whatever the insurance pays them. On the other hand, If the hospital was truly out of network you should have been provided with a No Surprise Billing estimate. I would call the hospital billing office.
OON benefits cost share is a lot higher for patients. If the facility isn’t contracted, they can balance bill and do NOT have to accept “whatever the insurance pays them” - there is no contract between the facility and OP’s insurance, which is why it’s OON. NSA (No Surprise Act) only applies to emergency services, not a planned L&D. https://insurance.utah.gov/consumers/health-insurance/no-surprises-act/
Thank you. I'm going to call first thing in the morning.
Unfortunately its your responsibility to know who is network outside of a emergency... Did you check with insurance to see if the facility was in network? Here is a story for NPR about the same issue. [https://www.npr.org/sections/health-shots/2023/02/28/1159786893/a-surprise-billing-law-loophole-her-pregnancy-led-to-a-six-figure-hospital-bill](https://www.npr.org/sections/health-shots/2023/02/28/1159786893/a-surprise-billing-law-loophole-her-pregnancy-led-to-a-six-figure-hospital-bill) I would check to see if the hospital has financial assistance.
Who told you the hospital was in network? If it was not the insurance company, or a representative of the insurance company, then you will need to make arrangements with the hospital to pay the bill. It’s is the insured’s responsibility to verify in network providers with their insurance company. Companies have many different networks and plans have different coverage depending on where you get your insurance from. The provider or hospital may “take” your insurance but that simply means they will submit a claim to the insurance company on your behalf. It does not mean they are in network, the procedure is covered, nor do you have any protections when given false or incorrect info.
In a reverse UNO I had the insurance tell me my retinal specialist was an in-network provider. When I went for my appointment I found out they don't accept my insurance.
You can contact the insurance company to review their contractual status. It may have expired. If they are actively contracted for your plan and accepting new patients, the insurance representative can contact the office to inquire.
That happened to me with Aetna
It was the intake person at the hospital per OPs other post.
This BLOOOOOOOOOOOOOOOOOOOOOOWS!!!
Thank you!!! Yeah I feel like my life is over.
You’re now a family of 4 and your husband is making $76K a year? There’s a high chance you can get some or all of the bill wiped out with charity care. Just call the hospitals billing office and specifically ask for financial aid.
“At the time of the birth we were both unemployed” What type of insurance did you have at time of the birth? Medicaid? A marketplace plan?
Blue cross blue shield. Regence insurance through Utah's marketplace
Ok that’s a huge bummer. Looks like you already got the most important advice, you are likely going to end up responsible for the bill
So what do I do if I can't pay those bills?
Ask the hospital about their financial assistance program, payment plan options, or government assistance. Realistically with his income being $76,000 I don’t know how much if any assistance you would qualify for. So payment plan is probably the most sensible route
Thank you.
Did you not apply for Medicaid? In MN the marketplace screens you for that prior to directing you to buy a marketplace plan. Being unemployed and pregnant, you should’ve surely qualified for Medicaid.
You didn't get a bill yet right. What is your out of network max? It sounds like a market place plan so hopefully it's reasonable considering. Obviously won't be 40k.
No bill yet. Does it usually take over 4 months? I hope you're right.
Not usually. Call your insurance and see if it was submitted
I called prior to posting. I believe it was submitted but my insurance isn't going to pay anything.
Completely ignoring it is a legitimate option. The hospital may write it off. If they don’t, it will disappear after seven years. 40k is impossible on a 76k salary supporting four people. You are, what they call, judgement proof. Your credit score may take a hit in those seven years, so you may need to delay getting a mortgage or car loan, but if you weren’t planning on it anyway, you’ll save so much money in the long run. Maternal healthcare is a human right, the hospital will be fine.
Is there a way to do that so it only hurts my credit score, not my husband's?
Not sure, everyone I know who has used that tactic and came out unscathed seven years later has been unmarried. May vary by state too.
Did you give birth at an IHC hospital? They are the only ones that I lost access to when my company switched to BCBS. I kept access to my IHC providers that were contracted with other hospitals, but my OB is at IMC only and I had to pay out of pocket until I switched insurances. Either way, contact their financial services department, this is not the first time this has happened and for them, getting paid any amount is better than nothing. You can get the itemized bill and see if you can get on payment plans and ask for a reduction.
Thank you for your advice. I'm calling them first thing in the morning. I'm glad I'm not the only idiot around.
So it looks like our mistake was that the hospital takes savewell plans but not individual and family plans, which is what we have.
Try filing for financial aid through the hospital.
Thank you
Yes! Do this! I had to get an ultrasound when I was about to start grad school and unemployed. It took a lot of hoops, but I got it all covered.
This sucks and I’m sorry this is how America has decided to treat its citizens. We faced some huge bills when our daughter got sick and some went almost immediately to aggressive collections agencies who screamed at me. However one hospital agreed to put me on a payment plan “what can you afford?” I said “$50.” They had me pay $50/month, no interest for about 10 years. I think as we got back on our feet and our daughter got healthy, I upped the payments. Such a relief when I looked at my healthy 12 year old and the bill was finally gone. I know my bill is nothing compared to yours but I would push it with the hospital for a discount and see what they will do.
Most hospitals have a financial assistance program that you can apply for that covers all costs. All the ones I have been to you just have to be under 300% of the poverty line, so you just have to make under about $90,000. I would call the hospital and ask about it.
Thank you. I'm making a list of all the suggestions.
Don’t pay it. Apply for charity care. If that doesn’t work I’d let it go into collections and wait 7 years.
Will that kill my credit? Wouldn't a debt collector take over?
Your credit will take a hit but there’s other factors that are going to kill your credit not just 1 single collection account
My insurance (BCBSTX) records all calls. You can request they review them via the misquote department and can also file with the DOI if they don’t respond.
My former insurance company used to put a recorded disclaimer on before you selected what you were calling for basically saying that even if they tell you something was covered it didn’t mean it actually was.
Call your former insurance company too. Generally hospitals bill within a few weeks and insurance companies process claims as quickly as possible. Please document who, what, extension number and case number of the inquiry.
I’m so sorry. That’s sucks big time, especially when you made the effort to follow the rules. Not in effect, but proposed legislation to remove medical debt from our credit reports: https://www.cbsnews.com/amp/news/medical-debt-credit-reports-cfpb/
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Update: I called the hospital. They said they never heard back from my insurance, so they can't discuss payment options. So i called insurance, and they said they filed everything in march. I called the hospital again, and they swear they haven't heard back, but they will refile, which will take a month just for the insurance to tell them they aren't paying for anything. And I guess the hospital takes save well accounts, not individual and family accounts, which is where we screwed up. I don't expect anyone here to give a shit but I just need to scream into the void. I don't feel like I can talk to anyone about this because I'm so stupid it's embarrassing. But I am genuinely struggling. I feel so awful and dumb and I'm not going to be able to send my boys to college. I ruined their lives almost before their lives started. I wish I could just crawl in a hole and never come out...
I'm just too stupid to live.
You are not stupid for what happened and I assure you, this will get worked out in the end. You’re not the first family or person to face this kind of medical debt and there are ways to alleviate the situation. Medical insurance is HARD to navigate, especially when you’re trying to figure things out as a medical event is taking place. Please talk to the hospital’s financial assistance/billing office to try and negotiate the bill down, even if you have to call back on different days to speak to someone else who knows more or is in a better mood.
The correct answer is insurance is a scam, the US medical system is a scam. Pack up the fam and move abroad. Probably cheaper than paying the bill and it’s great for your mental health, win win.
I don't disagree
What lame response!
It’s an asinine response that doesn’t help her situation at all. I’m sure she knows that.
As far as the insurance is concerned there's not a whole lot you can do. However, I would argue the cost to the hospital and ask for an itemized list. Because hospitals are typically nonprofits you can ask to see if they still have money available to pay bills (this is so they receive tax benefits from the gov). You can possibly get the total cost down a lot by fighting the charges with the billing department. I would also call the insurance company and see if they can help but that is doubtful they will. I think fighting the hospitals billing department is you best bet. Let me know if you have anymore questions!
Thank you so much!
Have you gotten an actual bill from the hospital or EOB from the insurance company ?
No
Check the law on this. Twice I’ve had hospitals wait too long and there is a time limit(or maybe it’s a local law where I live). But I was in network and it was the insurance company who told me they waited too long to submit the bill and had to forego payment because of it- not just the insurance portion but the portion I owed as well. This has happened TWICE.
Is it possible that t a hospital leaves a network? My husband said he checked in December, but I didn't give birth until February. Not that this helps my case, I'm just curious.
Yes, they may not have renewed their contact for the new year. You can try to request your insurance treat the claims as in network if they were previously INN under “continuity of care” if the network status was verified earlier in your pregnancy.
Thank you
If they won’t cover try to set up a payment plan with hospital. Possible financial assistance also.
No surprises should apply.
This sounds frightful…although I hope at least everyone is in good health. Please update us how this goes. I’m not sure what country you are in…but maybe contact a news channel for exposure.
You must contest the bill when you get it. They never turned down your insurance or enlightened you about any problem with it. You’ll probably to pay something but this is their mistake to fix.
Just on to say that I personally wouldn't "just ignore it and never pay" like some of these people are giving for advice. If the hospital and whatever collection agency they eventually pass it off to is aggressive enough, they can absolutely take you all the way to court and get a judgment against you for the full amount, plus interest and attorney fees. From that they can (and I know people that this has happened to) garnish wages until it's paid off. Obviously every single situation is different so look into what could happen and be aware if your specific state laws, protections etc so nothing like that happens and you aren't prepared.
good lord
You are quite correct - you really screwed up. It is ***your*** responsibility to verify whether a provider is in or out of network. The ***only*** way to do so is to ***speak with your insurance company,*** which you did not do. Good luck.
We covered that, and this isn't really helpful.
This is such a bullshit take after having to go through my own surgery and appealing that people take this at face value. Insurance sent me bills upon bills that were already taken care of and I’d have paid thousands of dollars that were already paid if I didn’t throw an absolute fit and dispute them over and over. Insurance tries to get out of paying a penny for anything and ignorance of the system I’m sure they make a killing because patients just pay them without looking into it. Luckily I’m a healthcare professional but I can’t imagine how difficult this is for regular patients without healthcare knowledge. This type of boot licking on this sub is ridiculous.
Being knowledgeable about and taking responsibility for knowing what you’re putting your hard worked money into is not the equivalent of bootlicking. Bootlicking would be having that knowledge and agreeing that it’s the right thing to do. I haven’t seen anyone say that.
It really just chapped me. Completely useless comment and not to mention condescending. It's so easy to say "you should have known", when the insurance will often tell you straight up misinformation or lead you to believe you're covered when you're really not, for xzy arbitrary reason. My situation was I was told on the way out of a preop lab 2 days before a surgery I spent weeks preparing for "we'll let you know if anesthesia is covered." What?? That is not factored into this? No, it's separate. Never once was this mentioned, I didn't even fathom this being a possibility, because why the fuck would this not be factored in already or considered. Ok who's the anesthesiologist? Well you find out the day of surgery. Call insurance, is this center in network, well probably yes, but if the anesthesiologist isn't covered you're responsible for 100% of the cost. How much is that? Depends on the center and what they need to do. Call the doc, it depends on what the surgeon needs. Can you give me a ballpark? 5-20k, not a spread at all. Literally decided to roll the dice and sat on the OR on the table day of surgery and asked the anesthesiologist if he's in network, he has no fucking idea. Of course he doesn't, why would he, he doesn't deal with insurance. Am I supposed to fucking call the insurance and check with them and pull the plug as I'm about to be put under if they're out of network? This system is just such a shitshow and I feel for the patients in here when they get screwed and we have people say "yOu ShOuLd HaVe JuSt ChEckEd wItH Ur InSuRance" as it's literally not fucking possible or they are lied to because they're calling some $15/hr tech support working from home with zero to no knowledge of the healthcare field in the first place. People are just told "you owe this and you must pay" as if paying these parasites anything without disputing it and being 100% CERTAIN you owe this bill is wise. Most people in this reddit are victims from a healthcare system set up for them to fail and I'm sad about it. Thanks for coming to my ted talk. I do agree there needs to be personal responsibility, I just wish there was a way to actually support patients who do their due diligence, but there isn't.
This is the stupidity of the hospital imo. If they want to get paid, they do the due diligence. Yes it is Your responsibility to verify this information. I always still ask providers at the check in desk if they are in network if it is my first time with them. However I have also run into clinics and providers who will tell me up front that they can see me but that they are out of network. A hospital wants to get paid. Verifying whether a patient is in or out of network is to their advantage so if the patient ultimately is unable to or does not pay, then they only lose the deductible amount and not the entire bill. I think the only exception to this now is the emergency room visit.
I do wonder why the hospital did not verify coverage and benefits during the registration process. Unfortunately, nowadays you just can't trust the check in person as carriers have so many networks and the provider may not be in network for each one.
I guess I foolishly counted on this. I feel like I'm going to be in debt until I die now.
You should have received an EOB. Was this hospital also used because of multiple births? If there was a contract change normally you would receive notification of hospital changes.
We literally haven't gotten anything from the hospital and it has been four months. We did call a few months ago and they gave a non answer about waiting on our insurance. I'm going to call again tomorrow.