Hi Experts! A very happy new year to you all!! Here's my short story. We had our second child in May 2007 and I am covered with one of the best PPO-1 plans from Carefirst. My usual copay is $10 ( no deductibles), never had problem for the last 7 years including my first child's delivery. This pregnancy we received a hospital bill saying they paid $2K odd and that we owe them $300. I asked them why and they they its out of network which was very strange. They said the hospital is covered under the network but not some specific item (wonder what the hell that was). So I told the hospital to give me details on whay its out of network, which doctor/etc and waited for 5-8 weeks. They said they will get back to me and they never did. the next thing I know is I have a call coming in from collections asking me to pay up. They were very nice on the first 2-3 calls. I gave them the whole story and they agreed to file claims by working with the hospital and carefirst. After 4 months they called me today and said the claim was rejected. I asked them why they called after 4 months and they asked me to check with carefirst as to why it took so long. I explained to that lady its not my fault and that the hospital was to get back. She suddenly changed her tone and asked me why I cant pay $300 when I own a $400K home. I was so pissed I asked her to "mind her F#$@#ing own business". She slammed the phone down and asked me to face the brunt of a credit history problem" I just checked my online carefirst account and it shows me no "reclaims"!! Unfortunately I don't know the address of this agency nor do I have their numbers. They call me with a "private number". What do I do next? Please help me folks!!! thanks, much appreciated. Dodz.
I did... The insurance company says the hospital might have filed the claim in error as out of network. The hosipital itself shows as in-network per carefirst. The hospital says they know that everyone is in-network in their hospital but now say the case is with collections please deal with collections. The hosp guys were the ones to call me back, they messed up! Can the collections people damage my credit report? What next folks ? Thanks a ton. Dodz.
Actually you were responsible for the $300 until the details could have been worked out. That being said: Call the hospital, have them send you a detailed accounting and payments. Then call your insurer find out if the hospital can resubmit the bill. If too much time has lapsed you will be responsible for the balance.
Not necessarily. An FCBA dispute would have precluded payment until the disputed charges were resolved. You say you started getting calls from a collector. If the phone call was the first contact, did they send written notice within five days?
Actually you are right enigma. Most hospital admission forms do say payment is due when services are rendered and the filing of insurance done as a courtesy.
It would matter if it were an HMO, but the OP said it was a PPO. An HMO is a contract between the insurer, medical provider and the insured.
