ER visits and bills .....

Has anyone or their child gone to the emergency room and then receive a bill months later, for several hundred dollars because you saw a PA in the ER that did not take your insurance? This is the second time this has happened to me and we have the Empire NYSHIP plan. My 1 year old just got a bill from a creditor today. This is insane. We are in the ER for a reason and don't get to choose who we see. We clearly gave them our insurance info when we check in so I don't understand what the problem is. This is very frustrating. TIA

ER visits and bills .....

You said this has happened to you already -- what was the result of that 1st instance? Can you call a hospital administrator of billing/insurance? (I'm not even sure if this position or title exists but it sounds legit!)

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i could be wrong, but I thought since you were seen through an ER insurance had to cover who you saw? Id definitely fight that.

ER visits and bills .....

Submit it to your insurance. Depending on your coverage, your deductible should of satisfied your ER visit. Perhaps, this DR. thought he wasn't paid enough or perhaps its coded wrong.

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Def submit to your insurance, this just happened to me with an ER visit from October, my insurance mailed me a check for the bill

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This just happened to me. My dh went to the ER. I receive a check from my insurance company stating it was out of network and I guess they were reimbursing me. Then 2 days later I get a bill from the hospital for the same amount of money. I thought it was so weird and never happened to me before. Is this the new way of collecting payment?

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ER visits and bills .....

Was it submitted to insurance? There should be an explanation of benefits stating why it was denied.

We had an issue recently with empire not paying an er doctor and the EOB said that it was out of network but covered if part of an ER visit so I called them and they fixed it immediately and we were just responsible for out er copay.

ER visits and bills .....

Anytime there is an issue with a bill, I call insurance and the hospital billing department to find out more details.

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ER visits and bills .....

When a physician is out of network they may bill your insurance on your behalf but a lot of insurances will send you the payment to submit to the physician. Its how a lot of insurances work.

I would call your insurance company and find out exactly what the denial was and what you have to do to appeal. You may need to contact the bikling dept for the ER and you may need to speak with an administrator. Its usually a manager or director of er billing (some hosp have billers for specific dept.) Dont just speak with a random billing person speak with a amanger.

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This frosts me. This is called balanced billing and it really really should be ILLEGAL. If you are seen by an out of network doctor in an in network setting, you are covered. If your insurance coverage pays a bill and then you recieve a bill afterwards for the "balance" (this is after all your deductibles have been paid) than you should QUESTION, QUESTION, and QUESTION again. In most cases (i'll caveat with most because there's 10 million insurance plans out there) when a physician recieves payment from and cashes a check for service, even if its not the whole amount it is considered payment in full.

* Call the hospital and your insurance company.
* If you can not get the help you are looking for (ie, you should not have been balance billed) then start writing letters - return receipt, registered.

I've posted this before but this can become a full time job if you have a life threatening injury (like we were faced with) you don't think question the entire staff of support that have come to save your loved ones life. You dont think to ask when you are asking for them to do everything they can to ask -oh by the way are you enrolled in my insurance. And once you are able to breathe and the recovery road is set and you get home and you wade through mail you realize the bills. Our first one back was for $105,000 because the insurance company did not allow for surgery more than 24 hrs (and my DH surgery was 27 hrs), they paid $1,500 and told us we were responsible for the rest....that's what put us on the the road for understanding and reviewing and fighting (and winning).

Any questions please PM me. I'm happy to help.

ARTICLE

Organization to help with Balanced Billing in NYS

NYS Insurance FAQ on Insurance in Emergency Situations

Message edited 1/20/2014 8:31:20 AM.

ER visits and bills .....

My hospital was on the front page for what turned out to be an out of net work doctor there billing ten grand for a quick ER visit during which he did nothing. He'd been at the hospital at the time for another patient and was called down to look at this person for some reason. No one thought to ask if he was in or out of network as the visit took place in the ER. And, he did not disclose the fact which I think was horrible.

The people were fighting it, I do not know the outcome. But, shortly thereafter I was billed by the same hospital $2500 for a blood test that is usually covered. I made a stink and the doctor who looked at my results called me and said it would be dropped, that I shouldn't have been billed. So it seems that we have to be vigilant and always ask questions.

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ER visits and bills .....

Please also remember that almost every single insurance company requires you to basically call either while you are in the waiting room or within one day of the visit.

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ER visits and bills .....

Wow!!! That surprises me entirely! This was at Franklin general as part of nslij.... I received one of the bills years later and was furious. I simply made it clear to the person I was speaking with that I knew what they were doing as I work in the industry (I've been in health care for over 10 years) and that unless they were willing to work with us the could send us to collections, they weren't going to see a dime, and that I would let every media and news outlet that would listen to me know what they did to patients without coverage.

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I've seen this happen with hospital anesthesiologist s.

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This happened to me last year with Noah at Good Sam. I got a bill directly from the doctor. I called the doctor's office and told them I was NOT paying them. I called my insurance company and told THEM I was not paying. They worked it out. :)

ER visits and bills .....

Yes, this happened to us. DS needed a plastic surgeon to stitch up his face. My local hospital didn't have one on staff so they called one from Stony Brook and she did not take insurance. She billed us thousands. Don't pay the bill. Call the hospital and your insurance. The doctor can bill through the hospital. You hospital takes insurance.

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we have high deductible plan...

when dd ended up in ped ER - it was a $1,500 bill for us- after insurance discount and they ran no labs.

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I have had this happen to me during extended hospital stays. I don't know what to tell you except that it sucks. You do have the right to ask for someone in network but, if you are in the hospital.. who does that?

I am trying to remember but, I think doctors negotiated a little bit.