Medical billing question and could it be possible that I still owe more money?

Question

while disputing a medical bill, I had obatianed a copy of inof\formation that listed my correct insurance, stated I was an "inpatient" and had an account number. My insurance states they paid the bill in full, but my hospital insists only the hospital was paid in full, not other services that do not accept my insurance. A new employee printed out my information and I noticed it said "outpatient" for the entire visit and there was a different account number and they had a different insurance list that I don't remember applying for nor do I think I have it. Is this legitimate for any hospital to keep two sets of records for any visits?

Answer 1

We'd need additional clarifications to really answer the question as to whether the 2 account numbers are legitimate.

There are a few legitimate scenarios that I can think of offhand where you'd have 2 different account numbers for the same visit.  (One example - the hospital handles both the hospital and the physician billing.  You'd probably have a different account number for the hospital piece vs. the physician piece.)

Also, are you certain that the 2nd set of paperwork is definitely yours?  (Since you mention that it has a different account #, different insurance, and also outpatient status listed.)  Its always possible that there was another patient with the same and/or similar name as you who happened to be treated at the same hospital near the same time.

(It happens more often than you think, even for people with not-so-common names.  There have been a couple of times where I've had to query patient info, and realized that there was more than one person on the same date with nearly the same name!)

Aside from that....I'd ask the hospital what the reason for the second bill/second account was, and see if it sounded legitimate to me.  I can think of a small handful of scenarios where what you described might possibly make sense, but of course I don't have enough info to know whether you fit into one of those situations!

Answer 2

Firstly, hospitals do not keep two sets of records for one occurrence. They would not be in business long. They also do not bill for other providers. If you are receiving a bill from a provider, you should be able to contact your insurance and get an explanation of benefits as to how the claim was paid and what you owe. This amount should match what you are being billed for. If not, you should contact the provider and explain what your insurance says you owe. Contractual write-offs are often missed. It's also likely that this new employee did not print out the correct info and this further confused the issue.

If a provider was paid as non-participating and you did not have the option of choosing that provider, such as an anesthesiologist, you should not be penalized for that and you should contact your insurance to re-process that claim. Since you are asking for reconsideration, you can call and request it, but follow up with a letter stating who you spoke with and when and request it in writing. That way you have a paper trail if needed later.

Answer 3

Some hospitals are actually part of a hospital "system" that includes physicians as well as the facility.  Those types of providers have one tax ID number that they use to bill the insurance carrier for all services, however, they may have separate billing.  

As the first answer stated, I would verify that the services are truly yours, but keep in mind that you may receive one bill for each type of service.  You also may need to verify that all of the services were billed to your insurance.  If they only have record of one bill, they may not have been billed for the other services and may possibly pay for some or all of them.  Just because the hospital says that the insurance will not pay for the services does not make it true.  Insist on all services being billed to insurance.  In some cases, the hospital prohibits them from billing for services, but they also cannot bill the patient depending upon the denial from insurance.

Answer 4

It seems unlikely that they would be keeping two sets of books. I'd check to see that they are both actually your records. Could be that if two people with the same name have been treated, an employee could print out the wrong record. Alternatively, it might be that they divide the records into 'hospital' bills, paid by your insurance, and the bill for the 'other services' which have to be paid separately. Best thing to do is ask the hospital. Their accounts payable office should be able to check the records, and explain what the records mean.  

Answer 5

~~This isn't making any sense to me. The hospital should only bill you for their services. Outside services which you received from say other doctors or whatever, would not be billed by the hospital, they would be billed by the other providers. So why is the hospital billing for the outside providers. I'm wondering if there isn't an error in communication or a patient mix-up. You can ask for an explanation of benefits for whatever payments your insurance paid from your insurance company. As for the outside billing being done, you need to have the hospital provide you with why they are billing for outside services, and ask to see the denials they are receiving from your insurance companies. Ask for supervisors in the billing department of the hospital. Keep records of everyone you talk to and time and date. It sounds like you are getting a real run around and you need a person in authority of the hospital billing to handle this mess. In medical billing there is an excellent paperwork trail, and when you receive all the information I told you to request I think you will get an answer. Good luck!