I Need To Vent - Page 8

fortune · ‎03-14-2010

@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.

@chrystaltree

Thanks! So nice to have a hospital billing expert on board!!!

Jordan2 · ‎03-16-2010

I'm the OP and had cataract surgery on July 26. Well FINALLY after waiting 9 weeks for the hospital to send me my $400 refund (request for check was issued on December 6) I received it today!!!