A couple of years ago, I had a hospital stay while I was insured. Initially, insurance denied the claim because the hospital didn’t send enough information. I appealed and got the hospital to submit the required details, then didn’t hear anything about it and forgot until I received this bill. The hospital never contacted me about collecting.
I’ve spoken with insurance, and they said it was denied due to "prior authorization"either the hospital didn’t notify them in time, or they didn’t consider it necessary care. I went to the hospital for septic shock, so it was definitely necessary. Insurance said I can appeal again and wait for them to request the needed info. In the meantime, I’m trying to get more documentation from the hospital.
Even if it gets resolved, is it too late for insurance to cover it since it’s already in collections? I mentioned that to insurance, but they didn’t give me a clear answer. Am I screwed either way?
No, you still have time to file an appeal with the insurance company. I’d also like to threaten to contact the attorney general. Either the hospital must bear the financial burden of their own failure, or the insurance company must settle the claim. Turn up the volume. Most oil is applied to the loudest wheel.
I find it absurd that even though I have full insurance, I appear to be bearing the entire expense due to a clerical error. I’m not sure if I should engage a lawyer or if there’s a chance it will be resolved on another appeal.
I don’t believe a lawyer is necessary. I would call the hospital and request your documents, as well as file an appeal with the insurance provider. A complaint may also be made to your state’s attorney general.
For what reason is there a complaint? Which particular law did the hospital violate?
if they disregarded the requests of the insurance company or failed to file the claims on time. However, that is the purpose of requesting records. They have a paper trail. In what way, if they are experiencing septic shock, is this a non-emergency? It’s not the patient’s fault if someone dropped the ball.
Of course, complain to the AG. Perhaps the hospital will decide to rescind the bill after receiving some negative press.
It won’t matter 99 percent of the time. The hospital is not required to submit a claim to your insurance provider, and even if they neglected to do so, the amount will still be payable.
If a complaint is made, they will, at minimum, investigate it and request that the hospital take appropriate action. Most likely, the hospital will either modify the claim or write it off. I’ve worked on the backend of similar projects; it helps to write enough letters and create enough noise. They could go ahead and hire an attorney, but I’ve also seen self-motivated individuals succeed in this without assistance.
Give the insurance company a call and let them know what’s going on. Make an effort to contact a manager. Check if they can assist you.
It’s also never a bad idea to contact a lawyer who specializes in this kind of work. You can frequently obtain a free initial consultation. That implies they will meet with you at no cost and respond to your inquiries.
Even better, give the collection agency a call. It may surprise you to learn that certain collection agencies will assist you in getting the insurance company to cover the expense. Recall that they could care less about the source of the money as long as the bill is paid.
I received slightly contradictory information when I phoned insurance a few times. The medical network indicated they don’t handle appeals, while one person advised me to file an appeal with the hospital. Ultimately, all they said was to file an appeal and wait to hear back.When I informed the collection agency that I was challenging with insurance over the phone, they essentially stated, “Noted.”
Would the attorney resemble a debt or health lawyer?