Hospital billing error, where to turn

My son needed stitches.  We went to the ER, he got stitches.  They billed the insurance company.  Insurance company paid part of the bill, disallowed the rest, showed our responsibility as $50 co-pay only.  They are in-network, so no balance billing.  We have the EOB.  Hospital sends us a bill claiming we owe $1,150.  We call, we fax over the EOB and bill TWICE, we call again, they won't budge.  They conveniently claim they never received the faxes, but I have fax confirmation pages.  Now the bill is in collections.  I google the collection agency, and they have a horrible reputation for abusive tactics and garnishing wages for bills not actually owed, etc.  Great.  The woman at the hospital claimed that if I forwarded the EOB to the collection agency and showed that the bill was in error, that the collection agency would correct the bill.  When I call the collection agency and tell this to the woman who answered the phone she laughed at me.  She actually laughed.  I wish I were making this up.

As if that isn't bad enough, my husband had to be treated for heat exhaustion and dehydration.  Insurance is billed.  EOB shows us as having $0 responsibility.  Zero.  Same game as before, hospital sends us a bill claiming we owe $1,400.  Again, in-network provider, again, we have the EOB showing that we don't owe what the hospital claims we owe.

I'm doing my best to handle this, sending EOBs, keeping copies of the fax confirmation letters, etc.  At this point what else can I do, and who can I contact for help?  Division of Consumer Affairs?  Consumer Financial Protection Bureau? The A-Team?  I really don't want to have to end up paying over $2,500 that we DON'T owe, but also don't want our credit trashed because of this bullsh!t.  I could understand if we actually owed the money, but we don't.  We have documentation that states we don't.  They won't budge.

The worst part, my husband works for the f*cking hospital.  And the heat exhaustion/dehydration incident?  It was because they refuse to fix the air conditioning in the ambulance, and now to rub salt in the wound they're trying to fleece us for money we don't owe.

Something similar happened to me.   I called my insurance company and they sent the hospital a very pointed letter saying that they couldn't bill me for the  balance given that the hospital is an in network provider.  I was sent a copy of the letter and never heard anything further from the hospital.

Call your insurance company (phone number on back of your insurance card).  They should handle this.  I had a similar situation several years ago when my doctor's office sent my blood test to the wrong lab.  The insurance company handled it and I paid $0 since the error was made by an in network provider.

I would try calling your congressperson. Also, I would write a letter to the Division of Criminal Justice at the NJ Attorney General explaining the whole thing and asking for an investigation into the hospital's billing practices, and copy the CEO of the hospital. The NY Times has had a couple of articles recently on what a scam medical billing can be, it might be worth finding out who wrote the articles and reaching out to them to see if they have any advice. If the hospital is doing this to you, they are doing it to a lot of other people. 

By any chance was this at St. Barnabus?

In my experience, when all else has failed, engaging Twitter has usually gotten the attention of a highly placed individual, whose job it is to ensure excellent customer service. They will put you in touch with the *fixer. I've found that the person who first answers the phone, is a mere mortal like the rest of us, following a script and has no authority to say YES anyway.  

Although the insurance company should be helping you deal with this. 

rhw said:

By any chance was this at St. Barnabus?

Yes

Not Barnabus, University Hospital. By the way, UH is a state owned hospital, run in part by NJ tax dollars.  Yet for some reason their billing department is in Raleigh, NC.  I guess there must not be any NJ taxpayers in need of a job, which is why they have their billing dept out of state, good thing we have a zero unemployment rate here in NJ so we can send out tax dollars to give badly needed jobs elsewhere   

I contacted our insurance company after the first incident.  The representative tried to call the billing dept, but after being on hold for 20 minutes she was then transferred to a voicemail. She left a message.  Having tried to call billing myself on a few occasions I can attest that being able to reach someone being a coin toss.  Sometimes someone will pick up right away, sometimes I'm on hold for 20+ minutes, and then get voicemail.  I will contact them again tomorrow and see what they can do.

I asked my husband if it was okay to make a stink since this is actually his employer.  As much as it would hurt I said that if we can't resolve this easily I would even suck it up and pay both bills if he thought doing otherwise might harm his employment.  He says he doesn't give a f*ck, what they're doing isn't right, make as big of a stink as I want and just let them try to retaliate against him for exposing their fraudulent billing practices.  He's also a bit pissed because when he fell ill at work and was treated (by his co-workers no less, which I'm sure was embarrassing) he then went right back to work, didn't even try to go home early.  He was overheated and dehydrated enough that they started an IV on him to give him fluids, then afterwards instead of going to the ER for an evaluation, or going home to rest, he stayed and finished his shift so as not to leave his co-workers slammed with extra work for being down a truck.  His thank you from his employer is a bill demanding $1,480, which he doesn't owe as per their own contract with the insurance company.

And in yet another incident, not us, but one of his co-workers was injured on the job.  They billed his co-worker.  Repeated attempts at correcting the bill fell on deaf ears (sound familiar?).  This person called, mailed, even went in person to talk to supervisors.  The bill remained in this person's name.  The bill then went to collections.  This person then found their tax refund was garnished to pay the bill, a bill that they NEVER should have received since it was a workman's comp claim.  Again, an ongoing pattern of incompetent, or even outright fraudulent, billing practices. 

Finally, I have to say that the medical care at UH is excellent.  With my 4 y/o son they were also great about treating him with respect and keeping him calm.  I myself went to UH for tests a number of years back when they were still UMDNJ.  We have NO complaints whatsoever about the medical care, but their billing SUCKS.  As such, they aren't the only hospital around that provides excellent care.  Even as a UH employee my husband now agrees with me that we will no longer use UH unless it is a true life threatening emergency where going to another hospital would add too much transportation time, or God forbid it is a situation where a level 1 trauma center is needed.  

Spontaneous, sorry you've been treated so unfairly.  A check on Yelp shows that you are not alone in your complaint.  A business manager named Terry S. has been responding to the Yelpers' issues.  Might be worth giving her a call:  https://www.yelp.com/biz/university-hospital-newark

Elle_Cee said:

Spontaneous, sorry you've been treated so unfairly.  A check on Yelp shows that you are not alone in your complaint.  A business manager named Terry S. has been responding to the Yelpers' issues.  Might be worth giving her a call:  https://www.yelp.com/biz/university-hospital-newark

Wow, looks like my husband's co-worker isn't the only one to have their tax refund yanked because of their screwed up billing practices 

Stupid question, if you don't know the gender of the person you are writing to, how do you address a letter since choosing Mr. or Ms. gives me a 50/50 chance of being wrong?  It's actually Terri with an i, which seems to lean towards female, but I don't want to assume

spontaneous said:

Stupid question, if you don't know the gender of the person you are writing to, how do you address a letter since choosing Mr. or Ms. gives me a 50/50 chance of being wrong?  It's actually Terri with an i, which seems to lean towards female, but I don't want to assume

Dear Sir/Madame:

Now, Write to the very top person at the Hospital. Chief of Staff, CEO, whoever. Send the Letter by certified mail, return receipt requested. Be polite but forceful. Copy the Collection Agency and Insurance Company.

They cannot garnish wages, put a lien on your bank account or home without suing you in Court. You have to be served with a Summons and Complaint. If that happens call the law firm that filed the suit. Speak to the attorney or paralegal in charge of the account and follow up with fax and or certified mail. If they do not agree to drop the matter, file and answer and counterclaim for harassment and/or frivolous action.

Do not make payment! Doing so enables a fraud on both you and your insurance company.

 My letter to UH, hope this gets results.  And I kept it polite even though my husband is telling me I should flame the hell out of them   

As a University Hospital employee I am proud of the care that myself, and everyone at the hospital, provide to patients in our care.  When faced with medical emergencies, we have chosen University Hospital multiple times and have always received excellent medical care.  However, two recent visits have resulted in serious billing errors that are threatening my credit rating and my family's finances.  I am writing to you about this matter only because numerous attempts at addressing this issue through the billing department have failed.

On DATE, my minor son, SON, was seen at the emergency department at University Hospital.  Our insurance information with INSURANCE was presented at the time of the visit.  INSURANCE paid the claim on DATE.  University hospital is in-network, yet the billing department did not adjust the bill to reflect this and has been demanding payment on account NUMBER.  My wife and I called the billing department multiple times, we faxed over copies of the EOB to show that we were not responsible for the remainder of the bill, all to no avail. 

I also contacted INSURANCE directly.  The representative at INSURANCE confirmed that we do not owe the balance of the bill, we are only responsible for the co-payment.  The representative attempted to contact the billing department directly to address this issue on our behalf, but after being on hold for 20 minutes she was then transferred to voicemail, and she left a message.  This also resulted in no correction to the billing error.  The INSURANCE confirmation number for this contact is NUMBER. 

At this point the account for my son's bill has been sent to collections.  On our last call to the billing department we were informed that it was "out of their hands," but that if we called the collection agency directly at PHONE NUMBER, and sent them a copy of the EOB, that the collection agency would adjust the bill.  My wife called the collection agency and relayed to them what we had been told, at which point the representative who answered the phone at the collection agency actually laughed at my wife.  That this behavior came from a company that University Hospital has contracted with to represent them is unprofessional, to say the least, but that is another matter entirely.  Unfortunately, my wife was so taken aback by this rude reaction that she didn't even think to get the woman's name and simply asked for the fax number and then hung up as she was worried she might lose her temper if she engaged this person any longer than necessary.

We are desperate to have this billing issue cleared up, and are worried about how this mistake will affect my credit rating, and if my wages are garnished because of this error it will be financially difficult to provide for my family.

As if the above wasn't bad enough, on DATE while working for University Hospital, EMS Division, I was treated for heat exhaustion and dehydration.  My insurance information with INSURANCE was presented at the time of treatment.  INSURANCE finalized the claim on DATE.  Again, University Hospital is in-network with INSURANCE.  Yet I have now received a bill from University Hospital demanding payment for the bill. Again, I have an EOB showing that I am not responsible for the amount being demanded.  Normally I would take this second bill up with the billing department before even thinking of contacting you with this matter, but as the first account is now in collections and threatens not only my credit rating, but also threatens my ability to provide food and shelter for my three young children, I don't want to take any risks and am not treating both bills as extremely urgent. 

I am including copies of the bill for my son, SON, the EOB, and copies of the fax confirmation pages showing that I had made previous attempts at addressing this issue directly with the billing department. 

I am in no way trying to get out of paying a bill. I am being asked, under duress, to pay money that I do not owe.  The EOBs provided show that I am not responsible for these bills.  The fax confirmation pages provided show I have made good faith attempts to have this resolved.  I simply want this issue corrected, and any erroneous negative information in my credit files to be corrected.  Again, I am proud of University Hospital, both as my place of work, and also as an institution that I highly recommend to friends and family for the quality of care given.  My only concern is with these errors, and how difficult it is becoming to have this properly addressed. 

Also, as a paramedic for University Hospital who works in the streets, I am often unreachable during the day.  With this in mind, if you have any questions regarding these bills that is not answered in this letter or in the supporting documentation enclosed, I authorize my wife, DARLING WONDERFUL WIFE, to answer any questions and discuss these bills and my account on my behalf.  Her cell phone number is NUMBER.

If you are not able to assist me in this matter, then please forward this to the person or department who is best able to help me resolve this matter. 

Thank you for your time in this matter.

Sincerely, 

HUSBAND WHO SOMETIMES REMEMBERS TO PUT THE SEAT DOWN

I just texted my husband, he spoke with his co-worker, they garnished this person's tax refund without ever taking them to court.  Now it *might* be because UH is a state agency, so maybe they have a go around on that, one dept (UH) talks to another one (Treasury) and says "They owe us money, give us their refund."    However, since it didn't happen to me directly, I can't say for sure.  Maybe this person missed the notice in the mail to show up to court, who knows. 

LOST said:



Do not make payment! Doing so enables a fraud on both you and your insurance company.

Absolutely.  We actually still owe the co-payment for the ER visit but I won't pay that until the rest of this is cleared up so they can't try to apply it to the portion of the bill we don't owe instead of applying it to the copay.

Two pieces of advice:

1.  Contact this office:  New Jersey Department of Banking and Insurance, Division of Insurance

2. You letter is WAY WAY too long. Whittle it down to a few bullet points like you are talking to a robot. I guarantee you, nobody will read past the first paragraph. In fact, delete the entire first paragraph and just give the bare facts. My suggestions:

RE: Account # XXXXX

• My son was seen in ER on DATE.
• We presented XX insurance for payment.
• Insurance company sent us EOB showing the patient/family responsibility is $50. 
• We paid the $50 on DATE.
• We received a bill from HOSPITAL on DATE for AMOUNT.
• I notified you that our EOB from insurance company says we only owed $50, and that has been paid.
• You sent our bill to a collections agency.
• HOSPITAL is in the wrong. We do NOT owe any money on this account.
• HOSPITAL'S NEXT STEPS: Contact the collections agency to tell them you sent them my account in error. Send me an updated statement showing that I owe ZERO.
• MY NEXT STEPS: If I do not received proof that the above is done in 48 hours, I will:
  • Report HOSPITAL to the NJ Division of Insurance
  • Report HOSPITAL to the NJ Attorney General
  • Send a copy of this letter to hospital president [name] and every member of the board of trustees

After reading the above about the Dept of Banking and Insurance I checked out their website.  From there I went on a search and found something very interesting.  Are New Jersey Administrative Codes the same as laws?  Because N.J.A.C. 11:24-15.2 states (paraphrasing in plain English here) that if the insured stays in-network, then they are to be held harmless for the difference between what they billed and what they paid, it then goes on to directly say that providers can't balance bill if the insured stayed in-network.

So it appears that I don't just have the insurance company's contract on my side, but I also have the New Jersey Administrative Code backing me up on this

In the original legalese

N.J.A.C. 11:24-15.2 (b) 7, A provision whereby the provider shall hold the covered person harmless for the cost of any service or supply for which the carrier provides benefits, whether or not the provider believes its compensation for the service or supply from the carrier (directly or through a secondary contractor) is made in accordance with the reimbursement provision of the provider agreement, or is otherwise inadequate.

N.J.A.C. 11:24-15.2 (b) 7 ii, Providers shall not balance bill members who have obtained covered services or supplies through the HMO network mechanism.

Administrative codes are laws.

joan_crystal said:

Administrative codes are laws.

Awesome, so I can basically inform University Hospital that since they are in-network balance billing is against the law, and I'd really appreciate it if they would correct this "error" that they have been refusing to deal with

Look at #9 and #10

https://www.credit.com/debt/top-10-debt-collection-rights/

Go to the top.  Don't exhaust yourself with lower level employees.

The second bill (the one for my husband) is not yet in collections, so today I faxed over the bill and the EOB. That one is new, so I figured I'd give them the benefit of the doubt and try to address this one separately. 

After faxing it over I called to see if they received it. I understand I can't discuss my husband's account without him first giving them permission, I was literally going to just call to see if they had received the fax. Well, I never even got that far. After the automated menu, then the hold music, I finally got the message that I was being transferred to a representative. At that point someone picks up the phone, and before I can even say "hello" they slam it down. I didn't bother calling back, I'll call them later today or maybe tomorrow.

What kind of operation are they running there?

If your hubby became ill as a result of work (the second issue) you should not have to pay a thing. I would file a workers' comp claim asap.

hauscat said:

If your hubby became ill as a result of work (the second issue) you should not have to pay a thing. I would file a workers' comp claim asap.

Proving it was caused by work, and by the faulty air conditioning in the ambulance specifically, is difficult.  They can say he forgot to drink water (probably true) or it was the outside temperatures (not true, the high that day was only 83) that they couldn't control.  He's been injured at work a few times, and even has had a few surgeries, but injuries are easier to prove cause and effect than an illness. In the end, our insurance carrier is in-network, so whether its workman's comp or health insurance, at the end of the day it is zero out of our pocket.

And changing it to a workman's comp claim wouldn't solve the billing issue, as one of my husband's co-workers had a documented on the job injury and for whatever reason they screwed that up too and kept billing them directly.

I didn't know it then but had I, I would have contacted the Division of Insurance and Banking in Trenton as I reached out to them for assistance about 2 years ago for another matter and they were incredibly hands on and helpful. But something similar happened to us a few years back. Kid was injured and wailing, went to the ER, finger broken in two places, saw ER doc. Received small bill from St. Barnabas AND from ER doc's private office in Hasbrouck Heights. Seems he was a pediatric plastic surgeon on duty that and billed me separately for his services. His fee alone was well over $1700k. I hit the effin' roof. I did not request a plastic surgeon and the injury didn't require a plastic surgeon. I asked St. Barn if all parents when rushing their children into ER should yell out, "Hey, my kid needs help stat but I need in IN NETWORK doctor only!" I fought with then Horizon, St. Barn and the doc's private office for a year with zero results - at first. When the doc threatened to send my bill into collections is when I went more nuts. I notched up the calls, emails, Twitter frenzied feeds, etc and finally Horizon sided with us and deleted the charge 100% and nothing went into collections. It was almost a full time job and it lasted over a year. Stick to it and don't give up. Wrong is wrong. 

kibbegirl, Yikes.  Balanced billing needs to be outlawed.

I'll have to find the exact administrative code, but I believe that the law now states that if you go to an in-network ER then out of network physicians are to be treated as in-network.  I spent about 4 hours reading through various laws the other night, and I'm pretty sure that that issue was covered.

Looks like this bill might actually be settled.  I called the billing dept repeatedly, nothing.  I faxed them the EOB twice, they claimed they didn't receive the faxes.  When I called the billing department again they said that the bill had been sent to collections and that they could no longer correct it since it "was out of their hands."  Then when doing a search for the ombudsman for UH, I found their online compliance dept, where you can make complaints on a myriad of issues.  So I filed a complaint about billing.  48 hour later I received a reply that the error had been addressed (so much for UH supposedly not being able to adjust the bill after it went to collections) and that an updated bill would be sent to me showing the correction and that the only amount due was the co-payment. 

Good for you.  So NJ doesn't allow balanced billing?

No place allows balanced billing. It is part of the providers' contract with the insurance company. 

I think there is confusion about what balance billing actually is. Balance billing is when the provider bills the difference between the CONTRACTED amount and the FULL-PAY amount. The contracted amount is the amount that the provider agrees to charge in compliance with its contract with the insurance company.

Let's say the provider's price of an ER visit is $3,000. However, the contracted rate with the insurance company is $500. Your insurance company pays whatever portion of the $500 that's required by your particular policy. Let's say it's 50% (other policies might pay 70% or even 100% of the contracted rate, or might pay no part of the contracted rate until you satisfy a deductible). So the insurance company pays $250. YOU pay the balance of the contracted rate—$250. BUT, the hospital cannot "balance bill" you for the difference between the contracted rate and the hospital rate, which in this example would be $2500.

Balance billing does not mean billing for uncovered out-of-network care. And it does not mean billing for the difference between the provider's contracted rate and what your insurance pays.