[USER]

.. I went to the ER and was admitted for 2 days. I went to a hospital that has always been in network but apparently they had contract disagreements and were out of network for 8 weeks.

If they had been in network when I went, my bills would have been covered at 100% because we already hit our out-of-pocket maximum for the year. Neither the hospital nor my insurance company informed me that this hospital was no longer in network and they were back in network just 1 week after I was there.

I appealed to my insurance company twice and was denied both times. I was in communication with the hospital but they got tired of waiting and sent me to collections. Now the collections agency wants $15k. Unfortunately my situation happened a week before the No Surprises Act went into effect so that doesn’t help me.

I don’t want to get sued but I don’t feel that I owe this money and I am so angry about how it all played out. Looking for advice on how to handle this.

[Jeremy]

You’ll just have to pay it, honest truth. It can be argued that you still went at the time it was out of network.

[Jestine]

If it had not gone to collections, I would suggest calling billing for the hospital and ask for a discount. Almost 3 years ago I went to the ER and the radiologist that reviewed my scans ended up being out of network. I never met him and had no idea that he was out of network at a hospital that was in network. Insurance would not cover the bill because he was out of network.

A couple months later a bill went into place for balanced billing in our state, which would have prevented this.

I called the radiologists billing department, explained the situation, and asked what kind of discount I could get if I paid 100% today on the phone.

They told me 20%, which took off a decent amount.

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[Loretta]

Without going into patient info, did the hospital appeal it on your behalf? Was it denied entirely as not medically necessary? Or is this just your balance? Either way you can file a complaint with your state department of insurance (doi) on the basis you weren’t notified of their contractual status.

Typically, DOI requires insurers to notify members for this very reason. Hope this helps.

[Jakki]

I pay $25 a month on a $10k medical surprise bill. My credit score is 802. Make payment arrangements if you don’t want to pay in full all at once.

[Ashley]

Is your plan funded through your employer? If you don’t know, call the member services line on the back of your card and ask if the plan at that time was self- or fully-funded. There may also be a fine print blurb on the card saying something about “ABC insurance company is contracted to administer the plan, and does not assume any financial liability…” (self-funded).

If self-funded, this means the employer is the source of the money paying for claims. Take the bills to your HR department and explain the situation. Your employer very well may help and just tell the insurance plan to pay the hospital or negotiate on your behalf.

Credentials: I do the billing for a small surgery practice doing high dollar procedures and we are out-of-network with a lot of plans. I reach out to HR benefits managers for self-funded plan patients all the time to get claims negotiated and paid.

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