Claim changed 7 mos later…how to handle

[bc33]

Paid the bill after insurance immediately and today received a new bill for 800 for the same procedure. From what I received from surgery center it looks like the claim amount was changed.

A month after that procedure another family member had a procedure. But the insurance isn’t taking into account we would’ve hit the deductible sooner with the 2nd and owed less out of pocket.

Do you have any advice on what to say when we call? Can the hospital help?

 

[shiruz]

@bc33 I think the first is probably the hospital to get the itemized receipt and explanation of whether or not the code on the statement changed (which could've triggered a retroactive bill)

Then call your insurance company to see why they changed the claim amount that they would cover and have them walk you through it. Many times as long as it's not a clerical error, they won't just charge you for no reason. But, unfortunately, it's up to you to track down the info and play detective (which is stupid in my opinion).

 

[bc33]

@shiruz Thank you for your advice. We spoke with both the hospital and the insurance company. They blamed each other. Insurance said hospital changed the amount, hospital says they received a refund letter from insurance. Either way, we are over our max out of pocket by the exact amount on the sudden bill. Insurance rep sent for a full review of the account.

 

[shiruz]

@bc33 That's good that you can see the review of the account - was the hospital willing to send you the refund letter by chance?

 

[raptur3ready]

@bc33 I have bad news. My wife had surgery. Insurance paid for everything. FIVE years later we are told THEY made a mistake and we owed $5,000. Fought it for 3 years and lost. Had to pay $100/month for over 4 years. They have ALL they power.