I am a newbie and hopefully someone can help. I been doing alot of researching and am unsure what to do? My problem is that my husband had to be admited to the hospital last year the bill was a whopping 20,000.00 the insurance company would not cover I made monthly payments of $100.00 a month six months later I recieved a notice from collection agency telling me this account had been sent to them, can a hospital do this even though I was making them payments? Annone that could help please.
First, make sure the insurance company's refusal to cover is within the terms of your contract. Many medical billing errors involving insurance occur when treatment is mis-coded, the medical provider uses a different provider number from the one in the insurance company's system, mistakes are made in submitting the claim, such as errors in the patient or group policy id, etc. Of course, when the claim is not paid, the provider's knee-jerk reaction is to send the whole bill to collections, at list price. These are often fixed, sometimes months after claims are denied, if you put the right pressure on all parties, but CA's will generally not help you do this as they stand to lose their commission if the claim is paid as it should have been. There is as much savings to consumers from insurance companies enforcing their discounted rates for treatment, as for their actual payments to providers on behalf of the patient.
First I want to thank you for responding to my question so quickly time is running out here to get this taken care of. Yes the bill is almost correct the Ins.says it's pre existing. so anyways there are a few mistakes in the bill maybe a grand, should I send a validation letter to the CA and the Hospital and secondly do you think it's a good Idea to send the CA a CEASE & DESIST letter?
"Pre-existing"? Is this an employer provided group policy? If so, there is federal law governing inclusion of even pre-existing conditions under coverage. Make sure it is not being wrongly excluded as pre-existing.
Contact your state insurance commissioner. His office should be able to point you to the applicable federal law. I vaguely remember the notices that went out in the mid-1990s, when several provisions were put into law along the following lines: If you had group insurance thru your employer, and you changed policies or insurers, but had coverage up to the new policy on the old policy, the new policy could not exclude pre-existing conditions. This also allowed transfer of coverage of dependents from one spouse's policy to the other's, if made during open enrollment, or due to loss of coverage of one spouse, due to, say, loss of employment. If a dependent's insurability status changed (birth, adoption, marriage with new dependents), you had a period of time (I think 30 days) to include them under a group policy with no loss of coverage due to pre-existing conditions. Etc. I think those were the sort of provisions required by the new law. The insurance companies were required to send out notices to those covered that they had proof of existing insurance, which they could use to ensure full coverage under another group policy. It might have been under COBRA, or some add-on to COBRA.
Looks like this might be covered under Health Insurance Portability and Accountability Act (HIPAA). http://www.dol.gov/ebsa/newsroom/archives/pr010501.html http://www.dol.gov/ebsa/FAQs/faq_hipaa_ND.html
