Can I contest a medical bill that's due tomorrow?
February 27, 2013 2:30 PM   Subscribe

I had surgery in October of 2010, paid all of the expenses past insurance, etc., and haven't heard from the hospital in 2 years. I've since moved, and received a bill yesterday for $138 that is "leftover from my surgery." The bill is dated February 13, but since the mail was forwarded, I just received it yesterday. I have no idea a) why I'm receiving this bill now or b) what it's actually for, and my contact with the hospital has yielded absolutely nothing. The charges it lists are nearly identical to those that are on the bills I (thankfully) saved post-surgery. I've called their billing department a couple of times, to no avail. The gist of the conversations: "It's for the surgery. Pay it." What are my options?
posted by eenagy to Work & Money (5 answers total) 2 users marked this as a favorite
Send a letter explaining that you need to know what the bill is for. Include copies of EOBs from your insurance company and receipts for what you paid. Also call your insurance company for help and have them confirm total patient responsibility for the date of service for the provider they're trying to charge you for. If the hospital is trying to bill you for something they never billed your insurance, or billed your insurance too late, they can't hold you responsible for the balance.
posted by ThePinkSuperhero at 3:05 PM on February 27, 2013 [1 favorite]

From previous experience, many hospitals outsource billing to third party providers that don't have access to the internal billing systems that would enable them to tell you exactly what the bill is for. If you're not getting detailed information on what services were provided, what was covered by insurance, and what was patient liability, you may well be dealing with one of these outsourced providers.

The trick (which had I but known it in my own epic hospital billing struggle would have saved me hours on the phone with useless customer service representatives and bill collectors) is to get the number for the INTERNAL billing department that generates the invoices the third party provider sends out and collects on. These people should be able to give you an itemized breakdown of your charges, figure out what the $138 is actually for, and if you indeed owe it.

What you're going to want is basically for them to generate a list of all charges related to your patient name. These will probably be under a number of different account numbers for different services, so you'll need to find someone patient and helpful to get this. Then, cross-reference this with your old receipts and EOBs, and you should be able to figure out what they're actually billing you for.
posted by psycheslamp at 4:49 PM on February 27, 2013 [1 favorite]

If you want to contest it, which sadly may not be worth the time it will require for such a small bill, at *least* call them before it's due and tell them that you need some extra time and please do not report it to credit agencies until its been resolved. For medical bills, places are usually pretty good about this sort of thing. Ask for an extra 60 days.
posted by tylerkaraszewski at 4:50 PM on February 27, 2013

Some services you receive at a hospital have both a "technical component" and a "professional component." The professional component is generally a physician's service. For example, if you have an x-ray the hospital may bill you for taking the x-ray (technical component) and the radiologist may bill you for reading and reporting on the x-ray (professional component). Sometimes the hospital bills for both of these, but separately.

It can be hard to tell the difference between these on itemized bills, because a similar description may be used for both aspects of the service. A pathologist may have examined tissue that removed as part of your surgical procedure. The hospital may have listed a charge for preparation of the pathology sample. This could be the reason that the service you're being for billed now seems nearly identical to a service that was billed in the past.

Sometimes the arrangements between hospitals and physicians changes, like when a hospital ends a relationship with one group of pathologists and begins contracting with a different group. At times there are problems adjusting the billing process for these changes, and the result may be discovery of some past services that were never billed. Until now! And it may be, as TPS suggested above, that now it is past your insurance plan's deadline for the hospital to submit a claim. Since it has been over 2 years, that is very likely the case.

A hospital should provide an itemized bill on request. Like psycheslamp recommended, you may need to find a different phone number; check the hospital's website, or call the hospital's main phone number and ask for a patient accounts supervisor. You may also want to call your insurance plan, even if you no longer have that insurance coverage, and ask for their help in understanding what is being billed now, and what your responsibility may be.

(If anyone is reading this from outside the U.S., you can stop shaking your head and/or laughing at our "system" now!)
posted by Snerd at 5:44 PM on February 27, 2013 [1 favorite]

I just wanted to second ThePinkSuperhero, I've had this happen a few times where for some reason, even though the hospital claimed that it had billed my insurance and that the balance left on the bill was now "mine", when I spoke to the insurance company, they stated they had never received the claim from the hospital.

Who knows which one of them was incompetent (maybe both), but when I told the hospital the insurance had never received the claim, they agreed to re-bill it and to fax it to them as well, and they did not require me to pay on the bill at that time.

Also, regardless of what the hospital billing department is saying, they have the ability to negotiate with you on this amount. If your main tack during the phone convos thus far has been "why am I getting this bill 3 years later and what is it for?" (understandably) and you aren't able to pursue anything in terms of passing it off to your insurance, I'd change the thrust of the conversation to "This bill is too high. I want to negotiate it down to a lower amount that is more feasible for me at this time."

You know, yeah, it's only $138 which is pennies relative to other medical bills, but they don't know what your budget is and my philosophy with negotiation is that the worst they can say is no.
posted by treehorn+bunny at 6:16 PM on February 27, 2013

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