hospital precertification error!!

**HandyMom** · 03-09-2007, 03:22 PM

I didn't know where to ask this, so move if you must. I've never had this problem before or since.

My health insurance carrier applied a $500 penalty to a recent hospital bill because the hospital did not precertify within 48 hours of my stay. The hospital is passing the penalty along to me to pay. I called both the hospital and my insurance company and the hospital claims it did precertify within 48 hours (since I checked in at technically 15 minutes past midnight) and the insurance says nom it was 4 days later.

I'm in the middle of this. I was told At the hospital and when I called about this bill that my hospital admittance WAS precertified within 48 hours. My contract with insurance says that the responsibility falls on me to make sure it's precertified. I thought taking their word for it was enough when I asked and they told me on that day that they notified my insurance and it was precertified.

I don't know what to do. Now the hospital is trying to say something to the effect that the extra charge is my deductable or co-pay. Not so. I have the itemized statement from my insurance company right before my very eyes.

$500 is a lot of money to pay out for someone else's error. My insurance policy states that the responsibility is mine to precertify if they do not!

What would you do?

??

**ama** · 03-09-2007, 03:24 PM

I don't have any advice but hopefully someone has some knowledge on this. I know my insurance is ALWAYS trying to pass the buck it seems when it comes to my health bills. Of course I pay them every payday and they take without fail.

~bumping this for ya~

**Darlene** · 03-09-2007, 03:39 PM

I don't know what insurance you have but mine, MVP, does have a $500 co-pay if you are admitted to the hospital. Hope you can get this straightened out and I guess next time unfortunately will be double checking to make sure they have what they need so you aren't stuck. Ugh, sorry your left playing hot potato with the insurance co & the hospital. Good luck!

**nwmissourigal** · 03-09-2007, 10:11 PM

I have worked in the medical field for 30 years and I have never seen this done. I would talk to the hospital. Your in the hospital and your sick so how are you supposed to call the insurance company. Your hospital is passing the buck. Call them on it and ask who they spoke to at the insurance company. When I am precerting I always get the name of the person I talked to. And the hospital that work at does they same thing. So ask the billing department of the name that they spoke to at your insurance company and see what they have to say. Good luck. Fighting these kinds of bills is very frustrating..Blessings..Kathy

**wanderinggrandma** · 03-09-2007, 11:34 PM

Also climb the chain of command. Start with the clerk, if not helped, ask for the name and title of her/his supervisor and extention. If you are not helped there, get name and title of her/his supervisor. Keep going. Be patient and persistent. If phone calls don't work start the letter brigade. This is the hospitals error or so it appears, not yours. Ask for accountability. Good Luck.

**HandyMom** · 03-10-2007, 12:25 AM

Thanks for the advice. These bills ARE frustrating and it's just as bad as it was years ago when I had a surgery and an HMO that didn't want to pay. I was on the phone everyday for months and sent letters, sent certified letters, had to copy billings... it made me a nervous wreck. I even wrote to senators and congressmen over it and the state insurance bureau.

No one wanted to pay the bill or admit there was an error but I was caught in the middle until it was turned over to collections and then I had to fight with them,too. It never did get resolved and they sued me and tacked on court and lawyer fees. Now my credit is ruined and I wonder what they think they can do to me since I have nothing of value except my home (and the value of that is questionable at this point).

I am so angry now. I hate to say it but next time I am very sick I may be tempted to not say anything to anyone and just suffer and I hope that if I die, I die at home where they can't send a bill out for anything but removing my dead body. I've heard they will put a lein on your home if they can't get money any other way out of you.

Thank you for the prayers and good wishes. I can really use them right now.

**jkelstaten** · 03-10-2007, 12:46 AM

If the hospital is telling you that the pre-cert was done within the correct timeframe then they should have record of the conversation in your file or one their computer records. Ask for that information and present it to your insurance company.

**HandyMom** · 03-10-2007, 01:12 AM

Originally Posted by jkelstaten

If the hospital is telling you that the pre-cert was done within the correct timeframe then they should have record of the conversation in your file or one their computer records. Ask for that information and present it to your insurance company.

I did ask the hospital for the proof and at first, she said it was a conversation and nothing written and then she said it was just a bunch of scribbled notes and I told her to send it to me and she (hospital billing rep) said she would get that in the mail.

**frugalnana** · 03-10-2007, 02:35 PM

Handy Mom I feel really bad for you. I think your getting the run around. Usually when someone precerts you coming into the hospital they are required to get the name of the person. What is certed and a call back number. When I did precerts I always got a confirmation number, so later if we had any questions, we could call back and give the number.
I wouldn't let them stick you with the bill. It sounds like the hospital made an error. Next time if you go to the hospital either call on your way or have someone call and let your insurance know you are going. Then call back as soon as you can and take name, contact number and any conf. # they may give you.
Good luck.

**McD** · 03-10-2007, 08:48 PM

What always works for me is threatening to call my Congressman and reporting the deplorable condition of healthcare in that facility. I've pulled that card three times now and I got the results I wanted in less than 45 seconds each time.

**HandyMom** · 03-11-2007, 01:04 AM

Originally Posted by MrsMcDowell

What always works for me is threatening to call my Congressman and reporting the deplorable condition of healthcare in that facility. I've pulled that card three times now and I got the results I wanted in less than 45 seconds each time.

I'm making a note of your suggestion. Thank you so much for your help. I'll keep you updated because if this happened to me, it could happen to anyone and it makes me angry to know that it probably happens a lot more to people who aren't looking as closely at their hospital bills. There are patient advocates getting paid to do this for a living, it's that prevalent!