Outrageous NICU bill

Our DD who will be turning 2 in a few weeks was born at 28 weeks and spent 2.5 months in the Valley Hospital NICU in Ridgewood, NJ. Well, just last week, we received a call from the hospital that we owe $57,000! I almost had a heart attack! This was almost 2 years after our DD was in the NICU. They said they had been sending the bill to our old address since January. We were shocked since we thought our insurance had everything covered. Apparently, the hospital has been after the insurance company, Amerihealth for the past 1.5 years to get them to pay the bill, but the claim/s were denied because of the absence of pre-authorization for either consultations/tests...not really sure since I'm still waiting to receive the bill. My question is was the hospital or were were responsible to get pre-authorization? We were never informed by the hospital of any pre-authorization that was required for anything. The hospital was willing to settle for $20,000, but we dont have that kind of money and nor should we have to pay this bill if it was their responsibility to get pre-authorization. This is very upsetting, especially after all we went through. Any advice would be greatly appreciated!

Outrageous NICU bill

I work in the medical billing field and as far as i know they should of gotten the pre-authorization for the consultations and tests once she was admitted to the hospital unless they actually told you that you needed to do

I have never heard of what they are saying, i would call the insurance company and inquire about it

Outrageous NICU bill

Agree with the above poster. I work in the healthcare field as well. When any kind of testing is done they should have checked or told you to check. I would contact your insurance comp and also confirm that they have the hosp appeals on file.

Re: Outrageous NICU bill

They should have gotten a pre-authorization. I also work in a hospital and know for a fact that we write off claims (meaning we take it as a loss and the patient is not billed) if we fail to get a pre-auth within a certain timeframe for a certain procedure.

Definitely call the hospital billing department.

Outrageous NICU bill

I would contact the NYS Dept of Insurance and file a complaint against your insurance company before it's too late.

Re: Outrageous NICU bill

I thought that for the nicu it was covered under Medicaid no matter how much money you make if the bill is over a certain amount. Someone correct me if I'm wrong.

Re: Outrageous NICU bill

Hospital should have gotten it. In instances like NICU there isnt time to get authorizations and care is needed. They should know if they need to call the ins first. If YOU were supposed to get them then they should have told you. Im sure these were routine things too where they didnt even mention to you.

Re: Outrageous NICU bill

In addition to what the above posters wrote, did the social worker from the nicu put your LO on medicaid? Anyone in the hospital 30 or more days qualifies. All of the non insurance bills for my twins went away after that process was finished.

Re: Outrageous NICU bill

Oftentimes, the hospital will make a mistake causing the ins company to deny the request. In this case, due to failure to obtain pre-authorization. I believe when this happens, the hospital Can NOT then pass this cost onto the patient. It's supposed to be in the agreement that ins companies have with the hospitals. Check into this by calling your insurance company first. If you call the hospital, they will look to settle for a lesser amt just so that they can recoup something.

Outrageous NICU bill

I have no clue about billing... but I know my ins company paid over $40,000 between me and ds 10 day nicu