Author Topic: Insurance billing question  (Read 916 times)

MustardTiger

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Insurance billing question
« on: January 09, 2017, 06:26:17 AM »
So, my daughter was born in April of 2016, but just a few days ago I got a bill that says it is from the birth from someone that is not the hospital.  (Not sure what is is for because it is not listed).  Also, we have of course reached my wife's deductible for 2016 but not yet the OOP.  I checked my insurance and they did file a claim and got a negotiated rate but didn't pay any part of this bill.  It is just around 350$ but I am wondering how they can bill me 9 months later, and why am I paying a bill when we have already reached the deductible?

Who should I call to sort this out, the insurance company or the biller?  Also what should I be asking?

Thanks.

chemistk

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Re: Insurance billing question
« Reply #1 on: January 09, 2017, 06:38:48 AM »
This same thing happened to me about 6 weeks ago, except it was from the birth of our son which happened about 18 months prior to receiving that bill. I was confused and irritated to suddenly have to owe a few thousand dollars to the hospital for something which should have been paid for long ago. I called the insurance company the next day and found out it was likely a clerical error. For whatever reason, the negotiated discounts between the hospital and the insurance company had changed but we still did not owe anything. When the insurance company sent the new rates to the hospital, it must have triggered a new invoice to be created and sent to us automatically. The billing discrepancy ended up being exactly the sum of the differences of the rate changes. I called the hospital to inform them of this and they cancelled the bill and updated our profile to show a zero balance.

A couple things that helped me: I always keep every EOB statement from the insurance company, and every bill from the hospital/doctor. I was able to go through and confirm through my bank (check images are available online for cleared checks) that each hospital invoice was paid in full. Because of this, I knew that I should be in the clear and had this information handy before I called insurance.

Gather any records you have, and make sure you can't find any differences that you might owe that you overlooked or that were pending and you pay have forgotten about. After that, call your insurance company and explain to them the bill you received and ask them any relevant questions (why did it take so long? why am I paying full price? etc...). Your insurance company should be on your side with this one, so you want their perspective first. Then, call the biller and ask them to explain the bill, why it took so long, etc.

You might end up having to pay it in the end, so be prepared for that, but there's also the chance there was an error that occurred somewhere.