Hospital visit, two years later get billed different than EOB- desperate, help! (medical, plan)

[KJA]

Two years ago I went to the hospital ER. Since it was an unplanned ER visit, I did not originally have my insurance card with me (just renewed at the time). Months after the service, I got a very large bill ($2k+). I called the hospital to update my insurance information with them. I also paid part of the balance. During the phone call I was told if they needed anything else or if I owed more than I paid I would be contacted.

Fast forward a year and a half and (through an exceedingly complicated and lengthy process) found out that I had been sent a bill from a collections agency for this same visit (sent to the wrong address). I've dealt with insurance and medical bills before, so I'm no dummy. The collections bill was not itemized so I called the hospital and requested an itemized bill. When I got it I compared it to the EOB from the insurance company I had at the time. The hospital is charging me for the EOB column titled "Discount Amount" which is the discounted amount that the hospital does not charge the insurance as part of their contract with the insurance company. Clearly I think this is a mistake and call the hospital. The hospital claimed that they did not/do not have a contract with my insurance company.

I got my insurance through my school who uses a company that was called Consolidated Health Plans, Inc (CHP), although now it is called Wellfleet. At the time, CHP had the First Health Network PPO and First Health is what was on my insurance card. Both First Health and the hospital's websites say that they are in network/accept that insurance.

I get the hospital to have the bill officially reviewed, but they came back and said since they don't have a contract with CHP I was responsible for that discount column (~$900). The hospital will not honor the discount. Now they will not have it reviewed again or budge at all unless my old insurance company sends them a contract that proves they are in violation.

During this whole thing, I was also in contact with the old insurance company and was working with one of their agents. Back in October she said since the hospital had an official review that she would have to work with First Health to provide that contract to the hospital. She said it would take about 30 days and that she would personally call me back and inform me of the verdict. It's December, past the 30 days and I hadn't heard from her. I called CHP/WellFleet twice this week and both people said that they would contact this woman to call me back and I would just have to wait until then. The first person I spoke to this week said that there was a note on my account that said that this was all billed correctly and I don't know what that means, whether the insurance paid correctly or the hospital is billing me correctly.

Over and over the insurance says they can't charge me for that discount amount and the hospital says I owe it and I have a collections agency out for me too. I don't owe this money!

TL;DR - Hospital is charging me for the EOB column titled Discount Amount although they have a contract with First Health which was used by my insurance provider CHP. Hospital bill says I owe about $975, EOB says I'm responsible for about $300 (part of which I already paid). Hospital will not budge on decision.

Please help! I don't know what to do and since this is in collections, I'm concerned about my credit score and how long this is taking!

[camaro69]

This is from my wife who worked in hospital billing.
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First call the collection agency and tell them you're fighting this with the insurance company and to put this on hold. So it's noted that you're still working on it.

Call the insurance company that you had at that time and tell them this should be covered and to resubmit it. If they wont do it speak to a supervisor or someone higher and insist you want this resubmitted.

If you don't get results, do the same thing, no matter how many times it takes.

Don't give up. It happened to me recently and after the 5th time, they paid it.

[Angie682]

I've worked in health insurance for many years and am an appeal supervisor at major insurance comapny. Here's what is going on.

Sometimes insurance companies take discounts they are not entitled to. Your insurance company needs to prove to the provider their is a written contract in place allowing them to take this discount.

Sometimes the providers are morons and don't take the discount inadvertently.

You are stuck in the middle.

You need to write a letter and send it via certified mail. Enclose the EOB that shows the $900.00 is a write off. Advise you do not owe this balance and the provider and insurance comapny need to work together to resolve the issue.

I would write a one letter to the provider, the collection agency, & the insurance company. I would also carbon copy the Department of Labor (if your plan is an ERISA plan it is governed by the DOL), your state's Attorney General.

If.that does not work contact your congressman and request they open a congressional inquiry in resolving this matter.

Good.luck!