Updated Watch Out For Oxford - Hospital Stay Related

So I get a bill today from the hospital for $650 for my stay after I delivered the baby. My insurance is supposed to cover it 100%. I call Oxford and they tell me that I have a 15% co-insurance. I told him I was looking right at my certificate of coverage and it says hospital stays and obstetrical inpatient care is covered at NO CHARGE. No where on the certificate does it say anything about a 15% co-insurance. It says 15% co-insurance on emergency room visits. I told him that, he said oh, it must be backwards. What?!

So then he proceeds to tell me that I can MAIL in a copy of my certificate to the appeals dept. Why should I have to go through all of this work?! They are the ones that printed up the certificate of coverage book and sent it to me. I don't understand why they can't just reference it. I'm so annoyed with the crap I'm having to deal with lately .

So watch your bills if you have Oxford. I hear it's common practice to try to bill the patient for more than they should be just to see if you will pay.

Message edited 8/1/2007 9:58:22 PM.

Re: Watch Out For Oxford - Hospital Stay Related

they do this to me too- i got bills after my delivery w/ DD for her care and my care- and it took almost a month to clear it up.

Re: Watch Out For Oxford - Hospital Stay Related

I'm still battling bills from my first birth, and what a fight Oxford gave me about not paying for a routine Level II sono.

Re: Watch Out For Oxford - Hospital Stay Related

Well, I called back and spoke with them about a physician bill I received from the midwife that I had previously set up a payment plan with Stonybrook on. I was told again, I have 15% co-insurance. I told her no where does it say that. She asked if my certificate said "HMO" on the top, I said no, it says "Freedom". She said I was mailed the wrong certificate. My card also says Freedom though. She told me to appeal that bill too. It's not MY fault they sent me the wrong certificate of coverage, so I really hope they end up paying it. I can't afford anymore medical bills.

Re: Watch Out For Oxford - Hospital Stay Related

They did the same thing to me. When I was struggling with preterm labor with my second I had to go to the maternity floor numerous times to get monitored and put on terbutaline. They charged me for each time I went even though it was 100% necessary. DH fought with them and we ended up not having to pay but I was so mad that they did that

Re: Watch Out For Oxford - Hospital Stay Related

I just wanted to update. They denied my initial appeal, so I filed a second appeal and also filed an online complaint with the State Dept of Insurance. I received a letter from Oxford today stating that my claims will be paid in full. I also received a letter from the State Dept. that says the case has been resolved and it included correspondence that they had received from Oxford stating they intend to pay the claims. So if your claims aren't being paid the way they should be, I highly recommend filing a complaint with the State.

Now I just got a bill for the epi which wasn't paid in full like it should have been, so I'll be appealing that one now also.

Re: Updated Watch Out For Oxford - Hospital Stay Related

It's ridiculous what these insurance companies put you through. They have no problem accepting your money all the years that you are completely healthy but the minute you need medical treatment they love denying claims left and right.

Re: Updated Watch Out For Oxford - Hospital Stay Related

I got another bill yesterday stating Oxford paid their portion and now I owe ONLY $269.00. It's so annoying, feel like I'm always talking to the wall when I call.

Re: Updated Watch Out For Oxford - Hospital Stay Related

Wow. We just switched to Oxford -- looks like this is what I'm in for. My previous insurance company underpaid my doctor's bill, so I got at $700 bill for the delivery. I called them and they stonewalled me telling me that they had paid the contracted rate and there was nothing they could do. I called the benefits person at work and had her give the bills to her contact at the insurance company. As far as I know, they are taking care of it. It seems like insurance companies just like to pull this BS to see if they can get away with it.