Community Chat

[Winkk]

I guess I'm somewhat confused on this.  I thought the insurance company was responsible for collecting the deductable not doctors or hospitals.  You just pay them the copay for whatever it is you are having done.  Why would a hospital be getting that deductible?  And, like someone else said it's not who files first.  They all get their money.  This whole thing sounds kind of weird.

[Jordan2]

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@chrystaltree wrote:

Hospital billing is often a mess and always complicated.  I do this for a living so I totally get it.  When it comes to deductibles, it isn't a matter of the doctor coming first or the hospital coming first.  The deductible is applied to the first claim in.  Your story confusing and I can't tell what is going on but I can tell you that the providers don't decide who gets what and they don't who the deductible is charged to.  It's an age old story.  Hospitals and doctors always want the deductible charged to the other one because they want payment from the insurer.  But the first one to get the claim, has the deductible applied to them.  You are getting lots of apologies but no (based on your story) did anything wrong.  I think they are apologizing because you are upset and it's hard explaining hospital billing to patients.  They hospital had every right to ask for the deductible.  They went online and as far as they could tell, the deductible had not been met.  That's all they have to go on.  There is always some lag time or processing time, so it isn't unusual for the system to show that the deductible has not been met when it has been met because there are claims "in the pipeline".  The hospital did nothing wrong.  It seems like your doctor's office created the problem because they don't bill the insurers promptly and they don't send out patient bills promptly.  Monthly billing is something we did 20 years ago.  No one bills insurers monthly anymore.  First because docs want their money sooner rathe than later and second, billing late cause this type of problem for patients.  Good luck getting it all sorted out and if you are due a refund, I hope you get it.  I can tell you that when these deductible things happen at my hospital, if we billed properly based on the information we had when the patient checked it....we do not refund the money.  We are only responsible for our payments and if we did everything correctly based on the information at the time, we will not adjust.  The rationale is that if there are subsequent deductible issues, the patient and the doctor's office have to work it out.  We just don't get involved.

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My understanding is the hospital should have billed me if they thought I owed my deductible (this is different from a copay). The doctor filed soon after my surgery, the hospital didn't file until August 18 ( the surgery was July 26).My insurance company spoke with someone from the hospital telling them what they contracted with the insurance company and they were paid by them, They should have never collected my deductible if they weren't filing a claim for almost 3 weeks. It's like first come first serve, they shouldn't have waited so long. I am most definitely due my $400 as I have now paid $1,400 towards my $1000 deductable.

[CatsyCline]

with medical i leave NOTHING to chance. i don't want surprises so  always make sure there is a pre-auth andd i know up front what my responsibility will be

the one time i did not do that i was billed 18k for a novasure ablation that should have been covered . it took many calls and fortunately i had the medial Hx to straighten that one out.   after that i always insisted on the pre-auth.  i'm sure i totally POd the office staff with my lumbar surgery. too bad. i learned a lesson and i will NEVER fork over any money up front. the odds that you get it back are slim. let them bill you.

[Imadickens]

I had a maddening experience! I had a radical hysterectomy in the morning and my phone rand in the afternoon. It was billing! They called to tell me that I must pay my deductible before I am discharged! (What were they going to do, keep me? That'd be the day!) After she finished her scare tactic I informed her I had paid the deductible when I was admitted! She didn't even apologize ! All I kept thinking was how wrong it was to stress someone who had just undergone major surgery!

[Carmie]

If the provider... Doctor or hospital is paricipating with your insurance, DO NOT pay them any money upfront that would apply to a deductible.  They are not allowed to blll you upfront.  This includes Medicare.

There is no way anyone could know ahead of time which claims will apply to your deductible or how much.

The provider can bill for upfront for coinsurance or a copayment.

[Carmie]

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@IamMrsG wrote:

Several years ago I had an ordeal with a huge medical insurance company.  It began with a store clerk's careless error on a handwritten receipt -- somehow, she wrote the wrong year, and I didn't catch it at the time.

It took several months and many phone calls to get nowhere with the insurance company.  What they did not know, however, was that I was keeping detailed records of every date, name and conversation throughout the time.

After I lost patience and hope of resolution, I sent a 20 page printout of those records via certified mail to the President of the company.  The claim was settled within a few days of receipt, and I was also told later that "positions were lost" as a result of my notes.

It's unfortunate that such steps are necessary when dealing with 'customer service,' but that's the way it is.  To this day, I take notes during a business call.  I begin with the date, phone number/extension and name.  If I miss the person's name, I have no qualms about asking them to either repeat or spell it. Notes are made as the conversation progresses.  The habit has frequently been helpful later, but, luckily, not to the degree I described above.  

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Insurance companies are not allowed to process claims in any other way than what was presented to them from the provider.

They need a corrected bill.  It is no longer possible for the insurance company to call the provider and get the information verbally.  They need a hard copy bill or a corrected bill submitted electronically.

I worked in Customer Service for an insurance co for over 25 years and things have changed due to HIPAA laws.

I am sure your packet of info was sent to CS where someone called the provider and insisted that they send a corrected bill.  There are CS reps who only handle "Presidential inquiries"

I would also bet that no positions were lost over this.  The error was made by your provider ...the store clerk, not your insurance company.

[Carmie]

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@Winkk wrote:

I guess I'm somewhat confused on this.  I thought the insurance company was responsible for collecting the deductable not doctors or hospitals.  You just pay them the copay for whatever it is you are having done.  Why would a hospital be getting that deductible?  And, like someone else said it's not who files first.  They all get their money.  This whole thing sounds kind of weird.

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No, the insurance company will never bill the patient or the provider of a medical service.

The patient is responsible to pay the provider any deductibles, coinsurance or copayments that were applied to the claim after the insurance company pays their share.

[NYC Susan]

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@Stray wrote:

I may be an outlier but have never encountered a problem with a hospital nor have ever been asked to pay upfront for a procedure or admission except for plastic surgery which was done in a private ambulatory care center.  And, that was explained well before the dates.. I live in the NYC metro area and basically go to the same hospital all of the time. 

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I've never been asked to pay upfront at a hospital or for outpatient testing or anything like that, either.  It goes through my insurance - They sort out the deductible, what they pay, and what my responsibility is.  It's been that way for as long as I can remember.   And I've been to several different facilities over the past few years.

[IamMrsG]

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CARMIE wrote:  Insurance companies are not allowed to process claims in any other way than what was presented to them from the provider.

They need a corrected bill.  It is no longer possible for the insurance company to call the provider and get the information verbally.  They need a hard copy bill or a corrected bill submitted electronically.

I worked in Customer Service for an insurance co for over 25 years and things have changed due to HIPAA laws.

I am sure your packet of info was sent to CS where someone called the provider and insisted that they send a corrected bill.  There are CS reps who only handle "Presidential inquiries"

I would also bet that no positions were lost over this.  The error was made by your provider ...the store clerk, not your insurance company.

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Regardless of the source of the problem, the error was unnecessarily 

prolonged by extremely poor customer service from the insurance company.  Whether positions were actually lost is of no interest to me, I merely relayed what I was told after the fact.

I have enough business acumen to have had no expectation of my packet of notes actually landing on the President's desk.  Furthermore, as long as the issue was properly addressed, I would not have cared if it had been re-directed to the company's janitorial department.

The point of my post was that in the interest of contractual obligation between us, expediency of good business practices, good will and customer service, it took entirely too much frustration, effort and time to resolve what should have been a simple and obvious issue. 

[handygal2]

I've learned that dealing with these medical billing bureaucracies can be a nightmare. That's why whenever l'm asked to give money upfront, l always object. But if it can't be avoided, l will NEVER pay with cash, check or debit card. Rather, l use a credit card. That way, if there's a problem or error, l contact my credit card company and file a dispute, while l defer paying the bill. That's better than having to fight for a refund of monies already paid in error.