Does the hospitol have a right to do this to us!

[rockyray13]

My husband was having shortness of breath and chest pains on a Friday eve so I took him to the ER. After they ran a bunch of tests on him they decided to admit him so that they could do a stress test on Saturday morning rather than have him wait until Monday. My husbands insurance (for which they had his insurance cards in hand as soon as we arrived at the ER) has a 2000.00 deductable and after that is met they cover 80 percent of the costs and we are responsible for the other 20 percent but this is only if he is actually admitted into the hospital ... As far as ER services go they only will pay 1000.00 towards that with a 250.00 deductable. When the doctor told us that he was going to admit my husband we agreed because we thought the insurance would cover this. Needless to say that about a month later we found out that due to the way the hospital coded his overnight stay by saying he was admitted into the obversation room, instead of actually saying that he was admitted as an inpatient .... his insurance company treated the whole ordeal as ER and wouldn't cover the cost .... They paid of the 12,674.73 bill only 757.68 and a PPO discount of 3,168.65 was also applied leaving us with 8,748.40 out of pocket that they state we are responsible to now pay. The Physician that was taking care of my husband tried to get the hospital to change the coding but they said it was after the fact and nothing could be done. I have tried to get the hospital to lower the cost of this bill since they knew it was a non-covered admittance (they actually wrote that on the forms either friday night or saturday morning) but they tell me that since we provided them with insurance .... they couldn't lower the bill any further .... it was already discounted with the PPO discount. My arguement with them was this ...... "I know that you can't change the codes that you applied after the fact ..... But I also know that it was your neglegence NOT TO TELL US THAT OUR INSURANCE DIDN'T COVER THIS OVERNIGHT STAY. ..... for if you had told us that we could of spoken with the doctor to see if it was an absolute necessity to keep him overnight rather than take him home and bring him back the next morning. I have argued with the hospital until I am blue in the face. My last conversation with them was since you insist upon treating this as an insurance incident then so will I .... I will pay the 2,000.00 deductable that I know we are responsible for and then pay you 20 percent of the remaining 6,748.40 that you say we owe. After that you will get it when I do. They politely replied that if I don't set up a payment plan with them they will simply turn it over to a collection agency for which I replied back .... Why should I pay for your neglegence ..... It was your responsibility to tell us that our insurance wouldn't cover the way that YOU DECIDED TO CODE MY HUSBAND'S OVERNIGHT STAY IN YOUR HOSPITAL because when we are told that he is being admitted ...... we have no clue as to what you decide to do thereafter unless you tell us.
So am I all wrong in my thinking ..... does the hospital actually have a right to do this to us ...... ? And can they actually turn this over to a collection agency if we pay them a few dollars a month ...... We don't qualify for indigent care or charity care ... we are just like everyone else .... simple folks trying to get by with the bills that we have in these pressing times . Please Help and thank you in advance!

 

[mightymoose]

Tough to say who should have done what... I understand your point of view, but that is only one side of the story.
Best I can say is that if you feel it is wrong, initiate whatever appeal process is available to you or take the matter to a judge.

 

[rockyray13]

I totally agree with the "he said, she said" response that you made. But regardless of those conversations the question that I want answered is ..... Isn't the hospital required to tell you if what they are about to do isn't covered by your insurance before they do it? For all non emergency situations they tell you up front what's going on before a doctor orders any tests, or they admit you etc ..... That I know for a fact. So shouldn't an emergency situation also be treated as such!

 

[jharris352]

The hospital is not required to tell you anything about your insurance. In fact it is specifically your responsibility. I know that isn't fair but it is the way things are. You are suppose to verify with your insurance what is or is not covered.

As for the hospital, I would put them on a $50 a month payment plan and pay until they get tired of it. They have to accept it.

Good luck.

 

[GeeksPie314]

I know this is an extremely late reply, but I work at a hospital in the Self-Pay department, meaning I assist pts' with any questions about the EOB's, and what and why the insur paid what they had, etc, etc, after insur paid. Or, if they are uninsured. Unfortunately I see this happen alot. When a pt comes to the hospital either on their own accord or with a physicians referral, if the attending physician has stated to the pt they will be admitted to the hospital, his intentioned very well may be to admit the pt. Most insurances, like Medicare, have guidelines that a pt has to meet now, in order to be considered to be admitted as inpatient. Observation is an outpatient service and it is VERY frustrating for the pt when they have been misled or are under the understanding they will be admitted. All hospitals code according to what the physician orders. If the physician felt the pt was not eligible for the admit, he/ she may order the pt to be observed until the pt's status improves. I don't believe that they could have changed the code unless, the pt met the insurance requirements to be admitted. So, that is probably where the hospital is saying no. It is not the responsibility however, for the billing department, physicians, nursing staff, etc to know what a pt's policy will deny or accept, pay for or not, etc. I advise pt's that inquire about whether or not a procedure is covered, to call their insurance. The pt needs to be updated on coverage because sometimes, when a policy changes, so does certain aspects of that coverage. We also have Charity Care available at our hospital. It is based on a debt to income ratio. Most pt's qualify for 25-100% adjustments off of their bills for past (not gone to collections), current and future bills. I would recommend really checking into the Charity Care option, even to see if you qualify. Sometimes, it may seem that you don't and then you do. If you don't, the only other thing to do would be to setup a payment plan. Ask the hospital what the minimum payment each month is. If you cannot afford it each month, ask them to make a note that you are going to make a monthly payment of which you can afford. They will not turn away your money. Then, every 3 months, call to check the status on your acct to make sure it hasn't gone to collections. As long as you are paying, it is not easy for some facilities to turn a pt over to collections but it does happen. I hope this helps.