Unexpected Bills from the Hospital After Giving Birth
April 25, 2010
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!
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!
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.
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 :))
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!
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!
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!!!
Ir the bills that you are talking about are a very large amount of money, which you can't afford to pay, the I would check with the hospital where you delivered your twins, and find out if they have a Medicaid Office within the hospital. Depending upon your income, you may be eligible to have these expenses paid off by Medicaid.
If the amount of your income makes that impossible, then I would contact the two doctors who billed you and see if you can work out some sort of a payment plan with them. As long as you give them some sort of a payment every week, or every month, they cannot turn your account over to a collection agency, regardless of how long it takes you top pay them off!
First of all "NEVER ASSUME"!!! Before the birth of my daughter I checked with both insurances to find out if the Dr choices were covered by our insurance. Some insurance companies don't cover all Dr.'s and they don't cover wellness. If our daughter was healthy my insurance would not cover her but my husbands did. If she is ill or something wrong then they would cover her. We had the same problem with the anethesiologist (spelling????). My insurance covered most of the bill but my husbands wouldn't cover the balance. We owed $1500 to him.
Thankfully he just accepted what my insurance paid and considered my bill paid in full. We owed nothing.
Unfortunatly becuase your insurance doesn't cover the Dr's you are liable. Always check these things before hand so that you are prepared. NEVER ASSUME ANYTHING. We thought the same thing and luckily everything worked out. Just because they are with the hospital does not mean that they accept your insurance. If the pedi you are using did not accept your insurance you better look into one that does. You do not have to stay with that Dr that was with your sons. You can change. If you stayed with the orginal pedi check again cause you will receive bills. No matter what you do the insurance will not pay if the Dr's are not covered. Grit your teeth and bare with it. Ask if you can make monthly payments if you cannot afford to pay the whole bill. They will work with you. Trust me I feel for you and there is nothing that you can do. Just make sure that the pedi you are using accepts your insurance and that they cover wellness visits. Good Luck and congrats on your boys!!!
Hi, I had this same problem when I had my daughter who was born 9 weeks early!! She was transferered to a NICU that did not participate with my insurance but was the best in Brooklyn. I later received the bills and spent many hours on the phone with the billing departmenat at the hospial and with my insurance. I was lucky that the hospital accepted whatever payment the insurance company made. My insurance would send me the checks directly and then I would forward them to the hospital. I hope this helps!!
Tell the insurance co.. in writing and on the phone.. that you used the in plan dr. .. and the in plan hospital.. you didn't call these dr. in (sonogram and pediatrician. Tell them the your in plan dr. used them.. and you didn't know that they were out of plan. Tell them to deal with your in plan dr.. and tell them you are't paying them. when you get a bill send it back saying you used the in plan dr. and that they have to take what insurance gives them since you didn;t call them to use them. Also send the hospital a note.. make sure you document all the people you talk to and all the names of the people you send letters too. talk to managers... and good luck.. don't give up. I had the same problem.. and finally the dr. and insurance companies worked it out.. i paid nothing. Be persistant.. and oh .. by the way.. so you don't end up on a list of non payment.. send the dr. $1. a month.. then they can't put you on a non payment list..
I'm going crazzzy with these bills I'm lost and i really dont know what to do I need Help! I'm only 20 years old and I though i was insured by UHP Family health care when i went to my ob/gyn visits or ultrasound appoitments i would always present my insurance card thinking it was good not declined or anything they would take it and then attend me and give me my ultrasounds or my monthly pregnancy check up......Well when i gave birth a day after giving birth they call me to my room, already giving birth and all they call me to tell me that my insurance has been declined or cancelled since 08, so im stuck and dont know what to do i had no idea i thought my insurance was good they were taking it at my ultrasounds and ob/gyn and never told me that so now i have all these bills coming to me from the hospital and labworks and my ob/gyn what can i do to get them covered pleasse help!
I received a weird bill after my son was born also for some kind of hearing test they did on him that I was unaware of. It was 2 years ago so hard to remember, but I think I just wrote a letter to the compnay that billed me, explaining that it was not my fault that someone out of network chose to give my son a hearing test without my knowledge. They ended up deleting the bill for me.
What I've learned in these kinds of situations also is to keep your cool when talking on the phone to these people. When you're really kind, they tend to be more helpful!
Unfortunately I had the same experience when I had my daughter (c-section also) and another time that I was in the hospital. I spent hours on the phone with my insurance company. For the first hospital stay that was not for birth, my insurance company ended up covering it because I didn't have a choice. It took several months of me calling but it was eventually resolved. For my c-section, however, I did end up paying about $300 because they said they no longer cover the full cost of a c-section. I still don't know how this is possible since it wasn't an elective c-section...it was necessary. Keep calling your insurance company, though, because it sounds like at least some of your bills should be taken care of.
Before I gave birth last year, my dr. told me I had to get a list of the pediatricians at the hospital and choose one that took our insurance to examine my son in the hospital when he was born. She said that if we didn't choose ahead of time, whoever was on call would examine the baby, regardless of whether or not they took our insurance, and we would be billed. Sounds like that might be what happened to you, and your dr. didn't let you know how your insurance worked. Hope it works out!
Deal with your insurance specifically. The hospital IS part of your insurance so it becomes the insurances problem regardless of who sees you or the babies! Don't take no for an answer and DO NOT PAY THEM DIRECTLY!!!! It is anoying and frustrating but keep making phone calls and go to the "top" of both your insurance company and the hospital if need be. If the hospital is covered ANYTHING in that hospital should be covered. A.
My wife & I had a similar situation. It's all about the paperwork. The items not covered need to be requested or referred by your doctor on paper for the insurance company to cover. Talk with your doctor & hospital if necessary to rework the billing write up.
I got them too for out-of-network docs used, unexpectedly. It was a little unsettling to me, as it seems to be with you. Afterall, we plan for so much, only to be blindsided by bills right when we are on leave from work!!!
When I called about my bills I was reminded that I signed paperwork at the hospital allowing them to take certain steps they deemed necessary, whether it was procedural or bringing in other doctors of their own choosing.
After this, I realized that only in a perfect world would all the docs working that day have been "in-network" for me. Then I realized how thankful I was that I didn't need any further procedures that day and that I had a healthy,cute baby with no complications...So I signed the checks and mailed them in.
That happened to us when I had my son and daughter. Most recently, my son had to go to the ER for something and the hospital is in our plan but the ER Dr.s are not in any insurance. Once the hospital billed in network, the insurance company upgraded the Dr.s to in network. However, I had to make the phone calls. Once the hospital was paid, I called the insurance comapany and they did the upgrade. When I had my son by c-section, the anthesiologist was not in my network. That required a letter stating that I didn't get to choose who the dr. was and that they should pay it in network.
So basically write the insurance company a letter with all the information of date of service and your i.d. numbers and tell them you didn't get to pick the sevices and dr. Be as detailed as possible. Send it to the company's Appeal department and that should take care of it.
I had the same problem with my twins (boys too!) and my older daughter. I got billed for the pediatrician visit and she wasn't on my plan. I didn't get charged for any sonograms (and believe me, I had about 50 of them during the pregnancy) because the hospital was on my plan.
I will tell you an awful story, though. In my first pregnancy, when I was 26 weeks pregnant, I went on vacation with my husband. While on vacation, I didn't feel the baby moving. Went to the hospital for a sonogram and learned the baby had died. Had to deliver the baby at the hospital with a doctor I didn't know (he was wonderful, though). In any event, I wound up getting thousands of dollars in bills for the LAB COSTS. Apparently, they did tons of tests on me and the baby to determine the cause of death. All the samples were sent to a particular lab that wasn't on my insurance plan. I called my health insurer and made the same argument you made: "I just lost a baby, I'm lying in a hospital, they sent the samples out... do you really think I stopped to tell them to make sure it got sent to a lab covered under my insurance plan??" My arguments fell to deaf ears. I wound up having to pay whatever wasn't covered under the plan. And it was such an administrative nightmare. I think they do that so you just give up....
I'm sorry this happened to you, but at least you walked away with two healthy babies!!!! Good luck with them!
Basicall its your responsibility to constantly ASK if they participate, or if this procedure is covered, or if there could be an additional charge, and the worst part is when you do ask they will say I DON'T KNOW and that they expect YOU to call the insurance company, and wait it gets better, because if you call with the wrong insurance codes, you could get a yes, or a NO and vice versa.
I would call the hospital and ask if they can negotiate a rate since its not covered, in addition ask for a payment schedule because they WILL and DO send these claims to collection.
I'm sorry, this does happen. YOu are supposed to be told ahead of time if someone who is giving you medical care is not part of your insurance plan. When you're in the hospital, they may consider you to be informed of this when they have a piece of paper hanging up in the admitting area saying that the radiologists, anesthesiologists, pediatrician group, etc don't participate in X, X, and X plans. If you want to fight the insurance company, here is what I would suggest. First, find out if there were any providers in the hospital that participate your group and if so, let the hospital know that they should have given you the option of someone who takes your insurance, and that they should cover the out of network portion. If there is no, for instance, pediatrician on staff who participates in your insurance and could have cared for your baby, then you may be covered. Here in NY, insurance is required to pay for a certain service as if in network if their network doesn't have a specialist of that nature (so if they have no midwives in your county on the plan, you can use an out of network midwife and be reimbursed as if in network).
It was sadly a mistake to assume the caregivers at the hospital are part of "the deal." There is no deal at the hospital. Every doctor who sees you is independent. They have privileges at the hospital, but they each carry their own insurance and participate in plans independently. Your hospital bills for their space and services and supplies, any doctor who sees you or your baby is something separate than what the hospital provides.
I hope that you are able to get reimbursed. I know it stinks. When I was pregnant with my first, my doctor tried to send me for sonograms at a place that didn't participate in my insurance. When I gave birth, they required that an anesthesiologist be present in the room even though I did not receive any medication at all, and he was not in network. The pediatrician who examined our baby after the birth was not in our network either. We had not anticipated these expenses. It was a wake up call.
Call your insurance company and explain to them that the sonogram was recommended by your OB (who I'm guessing is in network) and that you have no control who does what while you're in the hospital. They cannot hold you responsible for who sees you while you're an in patient. It's called "holding the patient harmless"; I work for a hospital and we recommend this to patients all the time. I'd say that 95% of the time, the insurance company will reprocess your claim and pay the out of network providers directly, or send you the check and you forward it to the physician.
M.. a similar thing happened to me after my twins were released from the NICU. i kept getting bills for $17,000! it seems the NICU was covered under my insurance plan, but the doctor in the NICU was not so every time he saw them--multiple times a day we got billed. call the billing dept and try to talk with them. sometimes you can get your insurance company to pay more or the billing dept can cut you a deal. it took us over 2 yrs to sttle this bill and we eventually did have to pay about $1,400. i was in the same situation, i essentially needed an emergency c-section because one of my twins was in distress. i knew the hospital was covered under my plan but nevr thought to ask if every medical person that i or my children come in contact with are covered under my plan--and certainly no one gives you this info! seems like a bit of a scam to me. if you can get your husband to help you out with phone calls etc, i would or maybe call your human resources person and see if they can help you resolve these issues. good luck. A.
I had a similar situation after a surgery about 5 years ago - everyone was in network EXCEPT the Pathologist. It took a few phone calls but was finally able to get the Pathologists office to accept the payment from the insurance company as payment in full. It was annoying because the pathologist (like the sonogram specialist you had) isn't something you even think about, or get to ask if they are in network :(
I had a similar experience when my son was born. My pediatrician doesn't do hospital visits, and I was billed for the hospital pediatrician's visit.
I called the hospital and insurance company and said that since the hospital had my insurance info, they should've sent someone in network and it's not my fault and I should not be billed. Everyone agreed and the charges were removed.
I didn't deal with this issue for a c-section but for another surgery. I know this applies to anesthesia and it may apply to your case too. If 2 of the 3 - facility, doctor and anesthesilogist - are in-network, insurance has to cover the 3rd in-network. The idea is that you don't have a choice who does your anesth. just like you had no choice in your situation. It can't hurt to ask! Good luck.
I understand your predicament but in the end you are going to have to pay up so you should probably just accept that now and not waste anymore time with the phone calls. I would find out if they will work out some kind of payment plan.
I had the same thing happen to me with my first son. The anesthesiologist was not covered nor was the lab. When you have an emergency c-section you have no choice but to use whoever happens to be there and how can the insurance company cover the hospital itself but not the lab in the hospital? I called both after my insurance refused to pay any amount toward those two huge bills. I spoke to people at both offices who then relayed my situation to the person in charge in the business office. Both called me back and made the offer of paying $200 and they would negate the rest of the bill. I took their offer because $400 was a lot less than $10,000!! I would call the offices for both and explain your situation maybe than can work something out with you so you can make a small payment in good faith, that you want to pay them but just can't afford the whole thing. My insurance would only cover one sonogram and I had 3 with my first pregnancy. After fighting them on the other two they agreed to pay one of them. I spoke to the office where we had them done and they let me pay the amount my insurance would have paid for the service. So I paid about 1/3 of what they originally billed me. It doesn't hurt to call, explain your situation and hope that something can be worked out. Good luck to you!!
This happened to me. My son was an emergency c-section and I was charged for the out-of-network NICU pediatrician (who never actually touched my son) to the tune of $500!! I called my OBGYN who contacted my insurance company and explained that it was an emergency and therefore they could not wait for a network pediatrician. The insurance company then reimbursed me for the entire bill.
The phone calls are a headache, but eventually the insurance company will cover most, if not all, of the bills. Talk with your OBGYN's billing office. They were a huge help to me!
Report it to your state's Insurance Department or the division in your state's Attorney General office. Also to the Hospital Board of Visitors & can do so w/ the Joint Commission of Health Care Accredition (JCAHO) located in Oak Brook, Il. This should help w/ getting it immediately resolved.
it happened to us too, my daughter was in the nicu for a week, none of it was covered, .... i cant imagine what they expect you to do!! we got billed for thousands of dollars. what a pain, dh was on the phone with the hospital and the insurance co. constantly for months. he found one helpful worker in the billing dept at the hospital and she gave him a bit of guidance, we got a chunk of it covered, in the end gave up and just paid the rest, which is just what they expect you to do. ive gone to battle with insurance companies a couple of times, sometimes with better results than other times. fight with them as much as you have energy for, and if you find one good person who works there, hang on to their name and number and only deal with them. keep records of all your conversations and keep copies of any paperwork. best of luck, and more importantly, congrats on the new babies!
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
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!
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.
you had no control over the doctors that were assigned to you. That's the magic statement with the insurance company..... the hospital needs talk to the insurance company again... as the original billing submission is likely using the wrong codes. .... its all about the insurance codes on the invoice....
I experienced the same thing after I had a c-section for my daughter ten months ago, only we were living in Alexandria Virginia at the time. I was billed for the pediatrician that saw her in the delivery room and the assistant surgeon, claiming that they were not participating providers. I too had no choice who came to the delivery room that day. What I did was, I called the insurance company and explained to them that I had no choice who assisted in the delivery and who examined the baby. They resubmitted the claim, stating that we did not have a choice in doctors and the insurance company ended up paying for those doctors. My advice is to call the insurance company, many times if you have to, we had to call several times before it was taken care of.
Hope this helps, K.
I had a similar issue when my daughter broke her leg. The hospital was in my insurance plan, but the radiologist they called on to read the films was not 'in the plan'. I called the insurance company and explained the issue, and that it was not my issue as it was not within my control. They completely agreed and dealt with the hospital & doctors. It was NOT my responsibility and I did NOT pay anything toward those charges. Be diligent. You are not likely liable (unless there are issues not described in your note, or, there are specific limitations on your policy)
Contact your insurance company again and ask to speak with a supervisor. Under the guidelines of your plan as long as the hospitalization was authorized and you used an in network facility and physician then all the billing would be covered. You have no choice on providers once you go into the hospital so the radiologist,anesthesiologist, etc who treats you while inpatient would be covered.