Need Help Re Insurance & Hospital Bill

[JanL]

I am 10 months post op and am still having problems with my insurance co. They only paid about 25% of the hospital bill, saying they paid "usual and customary charges". Would those of you who have had similar surgeries to mine (long fusion, T3- sacrum, A/P approaches, days apart) please share with me the amount of your hospital bill so I can see if mine is way out of wack or if I am just getting the run around. I know this is personal info but I only have your code names and you don't have to give the name of the hospital, just a brief description of your surgery and the amount of the hospital bill. I fear I am facing financial ruin!

Thanks

[Qikdraw]

One important question... Do you have a copy of your policy? If not you need to get one, as insurance companies do like to say you are not covered, even though your policy says you are. Thats the first step.

Brad

[briarrose]

I hope you can get this straightened out soon. I know how frustrating this can be. I'm fused T2 to L2 and my hospital bill was $270,000. My insurance company was refusing to pay for some things because they were out of network even though my hospital and surgeon were in network. I told them I had no choice in who helped out and provided all of the things during the surgery. I also had to tell them that certain things were medically necessary for this type of surgery (surgical monitoring). Those may not apply to your situation but it may give you some idea of what to do.

Good luck!

[bsprings]

Hi Jan,
I had surgery Dec '06 (T4-Sacrum) and the hospital was in network so I did not have an issue with their bill, but the doctor was not, and initially my insurance only paid about 15% of his bill. I wrote a letter prior to surgery explaining why I had to choose this dr (my case was very severe and he was the only dr. that expressed confidence in handling the surgery). I don't know if this detailed letter helped, but in the end they paid 100%. I can't really tell you what "convinced" them (other than prayer!), but I did start speaking with a manager (insist on this!) and she filed my appeal for me. I also told her I would be getting an attorney it it did not get resolved. I think you have to fight for it or they will not make a reasonable payment. I hope this helped!
Cathie

[JanL]

Thanks for responses. Even if you had no problem with the payment of hospital bill, I'd still like to know the amount so I can see what is the norm. My hospital bill was ~$530,000!!!! Insurance only paid $147,000.

[PNUTTRO]

contracts

Thanks for responses. Even if you had no problem with the payment of hospital bill, I'd still like to know the amount so I can see what is the norm. My hospital bill was ~$530,000!!!! Insurance only paid $147,000.

My hospital stay in July was under $100,000 and I was hospitalized 6 days. If you spent a longer time in the hospital or any time in the ICU, your bill would be bigger.

Also, did you get a bill from the hospital? You may not owe what was billed to the insurance company. Assuming you are using an in-network provider, the hospital and insurance will have a contract and agreed pricing for different procedures. These rates are usually lower than the "retail" pricing--as much as 50% lower. They first adjust the bill to the insurance rates and then bill you for your percentage after the adjustment.

If an in-network hospital is trying to bill you more than what was contracted, then it's fraud.

Assuming you are using an out of network provider, you may have to pay the whole bill. Without the contract between the hospital and insurance carrier, you don't have much power.

I hope you can work it out. Its not really about the total bill, but how the system works. briarrose is right. You need to call the hospital and the insurance company and see what can be adjusted. If you have someone at work that handles insurance issues, they can help explain or even make calls if there is something unusual.

p

[Jacque's Mom]

JanL - I recently had lumbar facet joint injections - once in July and another two weeks ago, recommended by Dr. Boachie, at a surgical center in NJ. My pain mgmt dr. did the procedure who is in-network. The surgical center I had it done at was not. The drs. office said they will accept what the insurance gives them. I was there a total of two hours. The fee for the surgical center was $6,175; anestesia $1,100; my dr. fee $4,000 - total a litte over $11,000. I receive a bill this past week for the July procedure saying I owe them $1,875 as the facility is not in-network and my insurance paid only $4,300. I called their billing number explaining that I was told they would accept what my insurance paid. The women was expremely nice, said she would call me right back and when she did she said "how about if I rebill you for $100, is that okay?" Huge difference from $1,875! I guess they try to get what they can unless you dispute it. I wish you luck. Lynn