Question
What is the name of your state? TENNESSEE
I WAS IN THE HOSPITAL OVER 2 YRS. AGO FOR THE BIRTH OF MY DAUGHTER. THE INSURANCE I HAD AT THE TIME COMPLETELY COVERED ALL OF THE CHARGES INCLUDED IN THE BIRTH AND HOSPITAL STAY OF BOTH MY DAUGHTER AND MYSELF. THE INSURANCE COMPANY HAS HAD SOME FINANCIAL TROUBLES AND HAS NOT YET PAID THE HOSPITAL. SO, I GET A
$1200+ BILL FROM THE HOSPITAL TODAY. I CALLED BOTH THE HOSPITAL AND THE INSURANCE COMPANY. THE INSURANCE COMPANY VERIFIED THAT I HAD COMPLETE COVERAGE DURING THE DATE(S) OF THE CLAIM, AND TOLD ME THAT I WAS NOT RESPONSIBLE FOR THE AMOUNT DUE AND SHOULD NOT HAVE RECEIVED A BILL FROM THE HOSPITAL. NOW, OTHER HOSPITALS IN THE AREA HAVE TOLD ME THE VERY SAME THING ON OTHER OCCASSIONS. I, THE PATIENT, AM NOT RESPONSIBLE FOR LATE FILING OF CLAIMS BY THE HOSPITAL OR NON-PAYMENT BY THE INSURANCE COMPANY FOR SERVICES THAT WOULD HAVE BEEN COVERED. THE HOSPITAL STATED THAT THEY HAVE NOT HAD ANY CONTACT WITH THE INSURANCE COMPANY SINCE THE INITIAL CLAIM, AND STATED THAT THEY WOULD REFILE THE CLAIM. AM I RESPONSIBLE IF THE HOSPITAL DOES NOT GET PAID BY THE INSURANCE COMPANY?
Answer
One More Bit Of Information: The First Woman I Talked To At The Hospital Told Me That They (the Hospital) Had Not Had Contact With The Insurance Company Since The Initial Claim Filing, But The Insurance Company Had Paid A Portion Of The Money And Will Be Paying The Remaining Balance. But, Since The Hospital Has Not Received All Of The Money That Is Owed To Them, I Was Sent The Bill.
Answer
Please do not type in all caps. It makes your post very hard to read and is considered, shouting, on the Internet.
The bottom line answer to your question is yes, you are ultimately responsible for any bills that are not picked up by your insurance company. But since the insurance company has already acknowledged responsibility and the hospital has said they will refile, I think you're jumping two steps ahead of yourself. Don't panic.
If the insurance company continues to delay, you may want to consider paying the bill just to get the hospital off your neck, and then looking for the insurance company to reimburse you. That's your call to make, however, and I wouldn't do it yet. Give the hospital and the insurance company a chance to work things out, first. Also, before you do that, verify whether or not the insurance company is REQUIRED by contract to pay the hospital (as opposed to paying you directly).
Answer
I completely agree with CGB. But, the only thing I will add is to validate the charges billed to you. Virtually all health insurance plans have patient co-responsibility. Even if you have coverage for your claims, there will be patient amounts due: deductibe and coinsurance, or "out of pockets". If these charges are in excess of deducticble and coinsurance, do as CBG says. lkc15507
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Thanks for the advice. I'm confused because, the insurance was state funded Medicaid. We had to be below a certain income level and have no access to any other kind of insurance in order to stay qualified. We met all of the qualifications at the time, and were not supposed to have a co-pay, deductible, or any out-of-pocket expenses. The insurance program has since "cut ties" with the hospital that sent the bill. I just do not understand how we could have a state funded insurance for the "needy" and still be billed so much by the hospital over 2 years later. Why did the hospital take so long to contact anyone? I am going through the appropriate channels with the insurance program, and the hospital said that they would refile the claims. If I am responsible, I will pay, but I am frustrated the help we thought we were getting may end up costing us "an arm and a leg" that we simply do not have to give. Sorry for the griping, thanks for the information!
Answer
Here's my 2 cents. If you had state Medicaid coverage, are you sure your plan wasn't a type of "spend-down" program or had other limiting restrictions on it? Since you say you had no deductible, co-ins or any out of pocket, I'm assuming it was traditional Medicaid and you would NOT be responsible for any out of pocket expenses. Did you furnish the complete Medicaid information to the hospital at the time of admission or at least before the Medicaid filing deadline was up? If so, the hospital is liable for not filing your claim timely. However, if you did NOT furnish the hospital with your Medicaid information, then you are responsible for the bill. I'm guessing there is just a communication error somewhere.
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I pre-registered with all of the insurance information that I was given/that was sent to me. The hospital, as I'm sure most medical offices do, made a copy of the insurance card. I believe the main reason that I was covered by Medicaid was because I was pregnant. It was my understanding that as long as I was seeing an OB/GYN that was in-network, and the hospital delivering was in-network, that I would not have any out-of-pocket expenses. Thanks for the information.