April 25, 2010,
M.L. asks from Brooklyn, NY on July 07, 2009
Unexpected Bills from the Hospital After Giving Birth
I am wondering if anyone has encountered the same situation I had and how you dealt with it. What happened was after 4 months of giving birth to two adorable boys, I started getting bills from the hospital. One from the pediatrician and the other one from the sonogram specialist. What I found out from the insurance company was that neither of these medical workers participated my insurance plan. These statements came as a huge surprises. How could they charge me for something I was not aware of and didn't really have a choice? The sonogram exam was recommended by the ob/gyn to check the position of the twins right before the c-section, and the pediatrician walked in to check on the boys after they were born. How would I know to ask if they were part of my insurance plan when I was laying on the bed recovering from the anesthesia? Anyone would assume that they were part of the whole "deal" since they worked for the hospital. I am just exhausted by making the phone calls between the hospital and the insurance company. Please share your experience and how you dealt with it. Thank you!
1 mom found this helpful
So What Happened?™
Thank you everyone for your advice. I took one of the advice to be an educated consumer and found a NY State insurance law amendment posted online prohibiting hospitals billing out-of-network charges to patience whose insurance plan covered their hospital stay. Here’s the website for the amendment: http://assembly.state.ny.us/leg/?bn=A.3230. With this information on hand, I called the hospital again and the situation completely turned around. It was a different representative on the phone this time and she was totally sympathetic and apologetic. Even before I mentioned the amendment, she told me it was an error on the hospital side. So for the charges of the pediatrician, they would accept the payment allowance from the insurance company. She would send the balance adjustment request in for the sonogram specialist part of the bill. I called them back after a month or so and the balance was zero. This is such a huge relief! Coming from a different country, I am still learning the all-too-complicated insurance system in the States. People are spending way too much time and energy on dealing with the insurance. It doesn’t have to be this way!
A.P. answers from New York on July 08, 2009
I haD THIS happen with the state-mandated hearing test. I wrote a letter to my ins. company, and included a copy of the bill. I explained that the test is mandated, the person who performed the test is not in the network, but I was not informed of that at the time, or given any options.
M.M. answers from New York on July 08, 2009
We had a very similar situation. I gave birth to (only one :) baby boy 8 months ago and started getting bills from the anesthesiologist... I did actually make sure when I chose the hospital (at the very beginning of my pregnancy) that every doctor participates in my insurrance, I made all the right calls and all... Now I was asked "who told me that the anesthesiologist participated? who did I talk to?" - obviously, I did not write down any names of anybody I spoke with... Apparently, it is our responsibility to make sure that every doctor participates before we choose them. Well, I did call the anesthesiology dept. early on (as I said) but now they're sending me (large!) bills with "nasty stickers" on them saying that we have to pay... I think, that I did all the right things. I was so stressed out that I asked my husband to deal with the phone calls... we also sent a letter - you should do that, so it is on the record.
Anyway, I have no real tips for you, just sharing my experiance. I hope it will work out for both of us. I will keep checking your post to see what other Moms wrote :))
Good luck to you, and congrats on a birth of your twin boys :))
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A.S. answers from New York on July 08, 2009
I had the exact same thing happen to me - I called my insurance company and told them that I had not chosen the $5000.00 anesthesiologist, nor had I known that the hospital was out of network (it was the only one my doctors delivered from). They resubmitted the anesthesiologist bill at in-network rates and the hospital wrote off the other charge.
A little diligence and you should get it all taken care of so that you can enjoy those baby boys and not worry!
1 mom found this helpful
C.Z. answers from New York on July 08, 2009
I actually hold a Life & Health Insurance Broker's license.
Unfortunately, this situation happens all the time, and you are correct, you did not have a choice of who did the procedure and you used an in-network hospital.
All you have to do is call the number on the back of your ID card and verbally log an Appeal and state even though the physicians were out-of-network, you used an in-network hospital, in-network OB/GYN and any specialists called in to assist should be paid according to your in-network benefits.
Let me know if you need additional help or have any other insurance type questions.
Good luck and congrats on your boys, they are great, I have three boys and one girl myself!
1 mom found this helpful
K.F. answers from New York on July 08, 2009
I only know the laws in NJ. So that being said, they can NOT bill you for something you had no control over. I did have that happen and the insurance company had to pay them. If the hospital is covered and they choose doctors for you, the insurance company HAS to pay them. You need to appeal it if they wont. (this is what I do for a living) However, in new jersey. I dont know if NY is different. Each state has different laws. Have you told the insurance that you had no control over what doctors the hospital chose? When all else fails, go to the HR dept. This is our job. If we cant help, we call our insurance reps to handle it. You should not have to deal with this. Good luck.
You know...I am reading all of these responses back to you and I am saddened. I am saddened to see so many women being taken advantage of by their insurance companies and hospitals. You are NOT liable if you are in the hospital and they chose a doctor for you that is not in your plan. That is something out of your control!! Look into your state laws. These insurance companies know that people like this will just pay so avoid a mark on their credit. Fight!! This is why we have so many issues w/ insurance now. They dont want to pay!! Become an educated consumer...especially when it is about your health and finances!!!
A.H. answers from New York on July 08, 2009
Before I gave birth to my daughter, my OBGYN told me to find a pediatrician b/c they would be checking on her in the hospital. So as I was doing my research, I looked for one in my network. It sounds like your doctor forgot to tell you this part. It's something that I never would have even of thought of on my own if my doctor didn't tell me. Does your insurance cover any out of network? We have great insurance and they partially cover some out of network. I'd try to negotiate a better deal or get them to drop the charges all together w/ the argument that you didn't know nor were you ever asked permission for them to treat you since they were out of network. Good luck, I hope it works out.
J.C. answers from New York on July 09, 2009
Fight, fight, fight until they pay or at least pay more then they normally would. If you gave birth in an in-network hoppital, the insurance company should be tking care of it. FIGHT!!
E.L. answers from New York on July 09, 2009
check with your insurance company...you should be able to fight the bills. it will get resolved...i have 9 month old twin boys...one needed to be taken to nicu right after he was born...to my surprise i received a bill for the specialist that treated him...neither myself(recovering for the birth) nor my husband was consulted on the doctor...with a few phone calls to both insurance and doctor office...it all went away. you have to be on top of all bills coming in your door!! it will take time!
N.C. answers from New York on July 08, 2009
Why don't you take your bills to the state. Sometimes they will cover bills that you can't aford or that come at a surprize. My advise is talk to the hospital. Sometimes they will wave a bill or reduce it. My daughter was a premi and had jandice. They had to give her meds that wasn't covered by my insurance. After talking to a hospital offical and they viewed the whole case the dismis the bill. Its a bit of work but it is worth it. Good luck