My medical insurance incorrectly processed a claim and now the hospital wants more money...who should pay?

Question

My son was born in early 2007. I paid my part of the medical claim in Jan. '08. The claim was reprocessed in July '08 and now my insurance says I owe the hospital an additional $400 even though insurance admits it was them who processed it incorrectly the first time. Do I have any recourse here with either the hospital or my insurance?

Answer 1

Ugh.  That stinks.  The thing of it is, though, that you owe the money.  If they had processed it correctly the first time you would have had to pay it then.  Instead you got an 18 month reprieve.  What they've done, really, is give you an interest-free loan for $400!

Still, it's not fun to have to pay more when you thought you were done.  Try giving the hospital a call and asking if they'll waive the extra money, or settle for a lower amount.  They should accept a payment schedule if you can't pay it all at once.  I have one friend who pays $5 a month!

Also, you may want to go back and check all of the hospital bills to make sure you weren't  overcharged somewhere.  That could offset what you underpaid.  And my insurance company had a program that paid me 50% of the charge for every error I found on the hospital bill.  I made over $1000 from the several errors in mine!  Not every company has such a program, and the front-line service people didn't  know about it, but I worked for the company so I knew about it. :)

Best of luck, and enjoy your son!

Answer 2

Try to possess as much information as you can maybe is one option,however it is time consuming,here is the one i have ever had good experience with.http://insurance.free-onlinetip.info/ins...

Answer 3

Nope...no recourse.  You owe the money, because it is based on the correct total amount you would have owed for the services that you and your son received.

If the claim had been processed correctly the first time, then you would have been liable for the charges right from the beginning.

Its not unusual for a claim to be reprocessed after an error was discovered.  (Usually within a year of the time that the original check went out for the claim, though technically the can bill you beyond that.)

Sometimes if a claim is reprocessed, it has no affect on your total liability.  Sometimes it works out in your favor (i.e. - you get a refund on some of what you paid).  And sometimes you owe more.  Either way, there isn't much you can do about it...its your part of the bill for the services you received.

Sorry.