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Hoping4Baby11
Live life to the fullest!,
Member since 1/11 2140 total posts
Name:
Jenn
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Medical Insurance Problems!!
Hello Ladies!!!
If someone had something like this happen to them I would love to hear your story!!
On July 18, 2013 I gave birth to a beautiful set of Twins 6 1/2 weeks early. They had to be in The NICU for a few weeks before we were able to take them home. I developed a high condition of Pre-Clampsia and was under the care of my specialist who was a participating doctor under my health carrier. They decided I needed to go over to labor and delivery at Good Sam who also was a participating Dr. I was contracting and started bleeding and I had to have an emergency C section that day. Afterwards my son and daughter had to stay in the NICU for a few weeks. During this time there were 3 rotating doctors in the NICU. It was a very hard time for us, not only where they in the NICU but I myself had to stay in the hospital because I was having serious blood pressure issues and they couldn't get it regulated. After 3 weeks my daughter came home 2 weeks later my son came home and everything was perfect until I received an EOB in the mail stating that the Dr. that my twins were under the care of in the hospital was not in my network. I immediately called Empire and they told me to write a hardship letter to them, which infact I did explaining every little aspect! When I didn't hear anything back from them I assumed everything was squared away. Fast forward to 6 months later when I started receiving bills from the hospital. I called Empire to see what the story was and they told me they sent me a letter that stated that they denied my claim and I had 30 days to send in an appeal. I received no such letter. Asking what can be done now they could not help me said he was past the 30 day mark of the appeal. They sent me a check for out of network expenses to be applied to the hospital bill. Getting nowhere I called Good Sam and seemed like they wanted to work in my favor. I sent them the hardship letter and a copy of the two checks from Empire. Now they want the checks to apply to the balance and they will work out a payment plan!!! How could something like this happen? I went to a participating specialist to a participating hospital!!How is this my fault? It was an emergency that my twins be born early and It wasn't like I picked this doctor. He was a rotating doctor in the NICU. I have contacted the benerfits Department that administrates my husband's plan but no one has gotten back to me. I hate to be sent to collections of something that was out of my control! Is there anything else I can do? Has anyone gone through this before? Need some guidance and assistance! Opinions Welcomed!!
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Posted 1/23/15 2:01 PM  |
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LSP2005
Bunny kisses are so cute!
Member since 5/05 19453 total posts
Name:
L
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Re: Medical Insurance Problems!!
Tell your insurance company "you had no choice in the provider and to bill them as in network because you were in an in network facility." Ask for a care coordinator to assist for your entire issue of both your l&d and the twins.
Message edited 1/23/2015 2:22:18 PM.
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| Posted 1/23/15 2:20 PM |
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jendar
happy bday mom! 7yrs married
Member since 12/13 1323 total posts
Name:
thank you mom. i love you
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Re: Medical Insurance Problems!!
Posted by LSP2005
Tell your insurance company "you had no choice in the provider and to bill them as in network because you were in an in network facility." Ask for a care coordinator to assist for your entire issue of both your l&d and the twins.
I agree. Its all you can do at this point. BUT dont give up!! Good luck
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| Posted 1/23/15 2:39 PM |
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cateyemm
Twins!
Member since 7/10 8027 total posts
Name:
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Re: Medical Insurance Problems!!
Posted by jendar
Posted by LSP2005
Tell your insurance company "you had no choice in the provider and to bill them as in network because you were in an in network facility." Ask for a care coordinator to assist for your entire issue of both your l&d and the twins.
I agree. Its all you can do at this point. BUT dont give up!! Good luck
 i have gotten past bills for many a hospital doctor this way. but you must be persistent and document absolutely everything.
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| Posted 1/23/15 2:56 PM |
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StaceyWill
It's a girl!!!
Member since 6/10 21536 total posts
Name:
Stacey
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Re: Medical Insurance Problems!!
Posted by cateyemm
Posted by jendar
Posted by LSP2005
Tell your insurance company "you had no choice in the provider and to bill them as in network because you were in an in network facility." Ask for a care coordinator to assist for your entire issue of both your l&d and the twins.
I agree. Its all you can do at this point. BUT dont give up!! Good luck
i have gotten past bills for many a hospital doctor this way. but you must be persistent and document absolutely everything.
ITA also. When I gave birth to DD, they tried to bill me for the guy who gave the epidural. I said I had no say in who they gave me. I wasn't about to stop him and say 'hey wait, are you in my network?'. They dropped it.
Good luck!!
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| Posted 1/23/15 3:06 PM |
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jendar
happy bday mom! 7yrs married
Member since 12/13 1323 total posts
Name:
thank you mom. i love you
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Re: Medical Insurance Problems!!
Posted by StaceyWill
Posted by cateyemm
Posted by jendar
Posted by LSP2005
Tell your insurance company "you had no choice in the provider and to bill them as in network because you were in an in network facility." Ask for a care coordinator to assist for your entire issue of both your l&d and the twins.
I agree. Its all you can do at this point. BUT dont give up!! Good luck
i have gotten past bills for many a hospital doctor this way. but you must be persistent and document absolutely everything.
ITA also. When I gave birth to DD, they tried to bill me for the guy who gave the epidural. I said I had no say in who they gave me. I wasn't about to stop him and say 'hey wait, are you in my network?'. They dropped it.
Good luck!!
When my ds received his hearing test, same thing, the dr was out of network. How the heck was i supposed to know!?. Claim too was dropped. Just keep on it. Its a pain and a headache but it wasnt your fault.
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| Posted 1/23/15 3:09 PM |
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MrsD121011
LIF Adult
Member since 5/12 1460 total posts
Name:
Elicia
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Re: Medical Insurance Problems!!
Posted by StaceyWill
Posted by cateyemm
Posted by jendar
Posted by LSP2005
Tell your insurance company "you had no choice in the provider and to bill them as in network because you were in an in network facility." Ask for a care coordinator to assist for your entire issue of both your l&d and the twins.
I agree. Its all you can do at this point. BUT dont give up!! Good luck
i have gotten past bills for many a hospital doctor this way. but you must be persistent and document absolutely everything.
ITA also. When I gave birth to DD, they tried to bill me for the guy who gave the epidural. I said I had no say in who they gave me. I wasn't about to stop him and say 'hey wait, are you in my network?'. They dropped it.
Good luck!!
Same here. Don't quit fighting them! Hospitals are sharks with this stuff! Tell them and your insurance company to fix it because it isn't your fault that the doctor they sent was not in your network. Go up the chain of command if you have to.
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| Posted 1/23/15 3:10 PM |
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Paramount
Sweet!
Member since 7/12 4287 total posts
Name:
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Medical Insurance Problems!!
I don't hve any time but I saw an article the other day that had to do with "Balanced Billing". That refers to what happened to you.
Here is the chart, but I don't remember where I saw the article. But it was a person who went a participating hospital, but one of the docs wasn't and it was a nightmare. The person got the whole thing "expunged" because of the law.
Google "Balanced Billing" and see what you come up with.
http://kff.org/private-insurance/state-indicator/state-restriction-against-providers-balance-billing-managed-care-enrollees/
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| Posted 1/23/15 3:14 PM |
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teaforthree
My Handsome Boy!
Member since 12/10 2549 total posts
Name:
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Re: Medical Insurance Problems!!
We sign so many papers and releases when we got to a doctor or hospital... Maybe we, as patients, should have a form that doctors and staff have to sign notifying THEM that we only wish to be treated by doctors who participate in our healthcare plan, and if a doctor outside the network treats us, we are not responsible for the payment. This way it puts them on notice that we are not paying.
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| Posted 1/23/15 3:22 PM |
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NYCGirl80
I love my kiddies!
Member since 5/11 10413 total posts
Name:
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Re: Medical Insurance Problems!!
Just keep on it. As long as the hospital is in network, it shouldn't matter who the dr is. It shoudl eventually get sorted. If not, there are agencies or an ombudsman who can help you appeal this for little to no money -
http://www.cms.gov/CCIIO/Resources/Consumer-Assistance-Grants/ny.html
http://www.livestrong.org/we-can-help/insurance-and-financial-assistance/appealing-insurance-claim-denials/
Message edited 1/23/2015 4:06:09 PM.
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| Posted 1/23/15 4:05 PM |
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LuckyStar
LIF Adult
Member since 7/14 7272 total posts
Name:
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Medical Insurance Problems!!
This gets me so angry. I want to call the hospital and scream at them for you. They KNOW you have no choice in who you see, yet they continue to bill. The doctor would be employed by the hospital- and therefore required to take whatever insurance the hospital takes. And if they say they take your insurance and it turns out they don't or don't like what the insurance paid them then they eat the cost.
These things can also end up on your credit report. I had a $70 bill from a lab once (I had a freaking UTI) and never made its way to me. Went into collections and onto my credit report. My doctor's office sent them the wrong insurance info and it was past the point of being fixed by the time it hit my credit report. The collection agency was actually very nice and wiped it off my credit report.
Keep on them. Good luck and I'm so sorry you have to deal with this.
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| Posted 1/23/15 5:46 PM |
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Hoping4Baby11
Live life to the fullest!,
Member since 1/11 2140 total posts
Name:
Jenn
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Re: Medical Insurance Problems!!
Thank You Ladies for all your advice and support. I actually got a cal back from the benefit dept and got no where. Basically they are telling me we have to pay it. She told me that it's in the plan of the way it is worked and can not be changed. She also went into how we are responsible after decutible!!! I went to a participating provider! I didn't choose this doctor at all. I have decided to keep on my insurance and sort out the Dr who saw my twins in the hospital! There has be a way to make this disappear!!! I tried to explain to her that I am not trying to get out of not paying it was out of my control! I still don't get it how this is our fault or responsibility!!
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| Posted 1/23/15 5:50 PM |
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FranM
And so it goes....
Member since 9/05 2217 total posts
Name:
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Medical Insurance Problems!!
It sounds like in order to be paid anything through your plan the Dr will need to bill through a participating entity ie the hospital. This will be some extra paperwork and a headache for the Dr so they wont want to do it. Otherwise offer them a payment plan of $5.00 a week to pay off the bill but only at you in network discounted rate.
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| Posted 1/23/15 6:09 PM |
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Aubreysmommy
LIF Adolescent
Member since 5/10 499 total posts
Name:
Baby Noelle is here!
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Re: Medical Insurance Problems!!
If you were admitted to the hospital and delivered via emergency c-section and than all of the follow up care was a result of that emergency (the babies being in the NICU) I thought the insurance company has to cover it and they can't balance bill you either. You would still be responsible for your deductible and co-insurance but the hospital has to accept what the reasonable rate is.
I just recently went to Stony Brook through the ER (I had at the time empire through the exchange which stony brook doesn't accept) and I ended up being admitted for kidney stones and empire had to pay even though no one participated, each EOB. Was denied, but once I called and told them it was through the ER they had to pay..and stony brook couldnt balance bill.
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| Posted 1/23/15 7:33 PM |
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Jenn79
One more?
Member since 2/12 2410 total posts
Name:
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Re: Medical Insurance Problems!!
I got charged for my the dr that gave me my epidural too. My dr, the hospital is all in network, and they don't have ANY anesthesiologist in network at the hospital! Okay, so I can go there and give birth, but I cant have any anesthesia!! Crazy! I ignored it for a year... But then I sent an appeal letter to my insurance saying that I shouldn't be responsible etc. I now haven't heard anything in like 6-8 months! So I'm hoping it disappeared now. Good luck! Send an appeal to your insurance who cares about the 30 days
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| Posted 1/23/15 7:37 PM |
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WhatNow
Say Cheese!
Member since 1/06 8033 total posts
Name:
A (formerly WhatNow?)
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Re: Medical Insurance Problems!!
A similar thing happened to me many years ago: I had surgery and the anesthesiologist who happened to be working with the doctor that day was out of network so the hospital started billing me because insurance didn't pay them. I contacted my insurance and said I had NO control over the matter and should not be paying for this because I confirmed that the hospital and the doctor participates in the insurance plan I had and therefore, everyone who touched me while I was on a gurney should be covered by the plan. They dropped it.
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| Posted 1/24/15 2:35 AM |
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WannaBeAMom11
LIF Adult
Member since 1/11 7391 total posts
Name:
Name
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Medical Insurance Problems!!
Keep calling the insurance company and the hospital. Tell the hospital to resubmit the bill to the insurance company. Keep documentaton of everything. How much is the bill?
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| Posted 1/24/15 8:15 AM |
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sunnyflies
LIF Adult
Member since 9/09 1757 total posts
Name:
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Re: Medical Insurance Problems!!
Posted by teaforthree
We sign so many papers and releases when we got to a doctor or hospital... Maybe we, as patients, should have a form that doctors and staff have to sign notifying THEM that we only wish to be treated by doctors who participate in our healthcare plan, and if a doctor outside the network treats us, we are not responsible for the payment. This way it puts them on notice that we are not paying.
Actually, THIS is a good idea. No, it's a great idea!
There should be a form, or some wording that we could add to the papers that doctors and hospitals give us that states we insist on having only in network doctors. It would include our insurance information so that there could be no mistaking our coverage.
For scheduled visits, I always tell doctors and hospitals beforehand that all doctors have to be in network, but to have it in writing on a form would be excellent.
Message edited 1/24/2015 9:15:56 AM.
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| Posted 1/24/15 9:12 AM |
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