Collections - NICU medical expenses

Hi everyone,

Our 2 yr old DD was born @ 28 weeks / 1 pd 12oz and was in the NICU at Valley Hospital in Ridgewood NJ for 2.5 months. A few months ago the hospital contacted us about a $57,000 bill for a reoccurring procedure that apparently was done without pre-authorization. Of course we were shocked and dismayed to hear about this bill. We asked to have this bill sent to us, but to this day we have never received it. In the last week, a collections agency contacted us about payment of this $57,000. I feel the hospital dropped the ball on this since the NICU should have obtained the pre-authorization for this procedure/s and after failing to get the insurance to pay for this came after us. How would we know that this or any procedure would need pre-authorization. If the NICU didnt or wouldnt obtain the pre-authorization shouldnt they have at least notified us so we could have?? Our DD was already in the NICU when this procedure/s was done and we couldnt be there 24/7 to know every procedure or everything that was done in our absence. I find this totally outrageous and have no intention of paying this , but we are afraid of being sued by the collection agency. Can someone offer some advice on how to handle this. We have been through so much already with our DD and this is only an insult added to injury. Thank you for your help and support in advance.

Collections - NICU medical expenses

Any advice/feedback would be greatly appreciated. What it comes down to is are we going to be sued by a collection agency over a medical bill in which the hospital/NICU performed a procedure without our knowledge or consent and in which pre-authorization was not obtained by them and which they never requested us to obtain? If this went to court, would we have a legal leg to stand on? I hope it doesnt come to that, but we have to know what we are up against. This is so unfair and I have no intention of being financially raped.

Collections - NICU medical expenses

We also never received this bill for these charges that were incurred over 2 years ago even after requesting the bill to be sent to our new address.

Collections - NICU medical expenses

First, I would contact the hospital directly to obtain this bill. They would still have records, and I would not get off the phone with them until you have someone who send them to you ASAP. Then, I would contact the insurance company to see what their response is in regards to the pre-authorization, and how or why you are to be responsible for the outstanding charges.

You're not going to be able to get out of paying by saying the bill wasn't sent, and ultimately there could be a billing error/oversight that is causing you to be responsible for the $57k. I would call everyone involved to see what the response is. It might be worth contacting the Attorney General, who I have heard can be helpful in healthcare billing errors (but don't quote me on that!).

Good luck!

Re: Collections - NICU medical expenses

I am sorry you have to deal with this I do believe the hospital could have obtained a preauthorization or what ever was needed. When I had my DD in 2007 I ended up with a ridiculous hospital bill since the anesthesiologist did not take my insurance at all when I had my csection. I fought the bill for like 6 months (it went to collections) in the end I did not pay it and the hospital washed it.

When I had DD 2 weeks ago I made sure while I was in labor that I asked the anesthesiologist if they took my insurance and checked my insurance on my iPhone prior to going to the OR.

Re: Collections - NICU medical expenses

not sure if this is accurate, but I thought it was NYS law that hospital was responsible to notify insurance within 48 hr admission, or medical need

Re: Collections - NICU medical expenses

First you need to look it up for a sample letter but you need to write the collections agency and ask for proof of debt. They will then have to obtain proof from the hospital whichwill put them on hold for a bit. Once you get that proof, then you can find out from insurance why they denied it. Then you can fight with the hospital over why they did not get the necessary authorization or tell you to. I hate to ask but if you knew about the bill but hadn't received it is there a reason you didn't fight it back then. You can also look and see how long they have to bill you in the first place.

Do not talk to the collections agency tell them you are disputing the debt and get that letter in asap. It will get them off of your back.

Collections - NICU medical expenses

Thanks everyone for your advice and encouragement. Here's the latest. I called the insurance company and asked them who was responsible for obtaining pre authorization for the outstanding charges. According to the person I spoke to and his supervisor, no pre-authorization was required for the tests/consultations in the NICU. He said the code for these charges was for maternity services. He resubmitted the claim and told me to call back in 5-7days. What I cant understand is how or why the hospital didnt know this and why the insurance denied payment. Can anyone please explain this to me. Thank you.

Re: Collections - NICU medical expenses

I would try posting this on FHF.

I can't remember the specific departments, but I know there have been ladies who have chimed in of exact people you can contact about this----especially if it is a local hospital.

Billing errors happen frequently with insurance. Take a deep breath. Most likely, with a little leg work you can work it out.

Re: Collections - NICU medical expenses

I would fight tooth and nail. We had some insurance issues because we switched to a new insurance company. My husband wrote lots of letters and eventually the charges were dropped because it was due to incompentant people not properly filing claims. You need to be very diligent in following up with the insurance/hospital and don't let them bully you.

Also, if your DC stayed in the hospital for more than 30 days you should be entitled the medicaid for the hospital stay which would have covered any out of pocket expenses. There shouldn't be anything that you need to pay for for his NICU stay.

Collections - NICU medical expenses

I was under the impression that the medical provider had to bill you within 18 months of the procedure, to get paid. Try calling your insurance company & speak with them.. Also, if you set up a payment plan with the hospital as long as you pay monthly you can't go into collections.. I.e... You can pay 50$ a month forever...

Collections - NICU medical expenses

Insurances LOVE to deny claims and get out of paying. Thats what they do. Its sad but at the end of the day its still a business. There are a few things that could have possibly happened. Especially since your saying you didnt get a bill for 2 years. The hospital def could have dropped the bill and your account somehow fell through the cracks and no one was managing it. I have had a drs office do this to me and fought it until they wrote it off. It was there error not mine for not managing my account.
You can ask your insurance company if the hospital called or appealed this in any way. They keep records of everything. You may have to contact a separate appeals dept BUT they keep records of every phone call and appeal. IF the hospital billed this and was appealing it, it should be on record.
I would also call the hosp, speak to a supervisor and demand a bill, proof of their appeals, dates with representatives names of who the hospital spoke with and so on.
And I say DEMAND to speak to a supervisor and let them know if they do not give you the information you will be contacting your lawyer. I mean this is $57,000 not a $10 copay.

Re: Collections - NICU medical expenses

Former NICU Mom here....


Any premie born in NYS qualifies for medicaid if their NICU stay exceeds 30 days. It pays any expenses not covered by insurance. I had medical coverage and still NSUH begged and pleaded for us to apply. Medicaid picked up any costs that my insurance did not. My co-pays were paid for by medicaid. In fact the first year of their life they (twins) had 2 insurance coverages. Primary being the family's and anothing else covered by medicaid.

Did you apply for medicaid for your child? If so medicaid will pay any bill not covered by insurance.

Hope this helps

Sorry... just re-read original post and I see that child was born in NJ. Not sure of thsoe laws.

Message edited 9/19/2013 12:23:53 PM.

Re: Collections - NICU medical expenses

Re: Collections - NICU medical expenses

I recently received a collection letter for my husbands surgery almost a year ago. It was from Winthrop Radiology stating there was no prior auth obtained. He had multiple xray and MRI's as he had surgery on his spine and was in hospital for almost 2 weeks. We never even received a bill from them. We called Winthrop first and they then called collections and put it on hold pending payment from insurance. I looked into it more and it was form they never sent into the hospital. In the end we do not have to pay it.

Call hospital first and see if they can take it out of collections first. (I do billing in my office and we do this all the time if people call). If they don't then call the collection agency and fight it that way. Hopefully it can be handled through the hospital and they take it out of collections.