Possible unfair billing? California

[avargas681]

Hi everyone, back in febuary of 2010 I had a lumbar puncture done at Anaheim Memorial in California, and now on July 20th I recieved a phone call from the hospital demanding a $500 phone payment or it will go to collections.  I have not recieved a bill from the hospital for this procedure in the past 6 months, and now, they are demanding payment.  I have never encountered this problem, but is this considered "ok", or has the hospital violated a fair billing law?  When I initially paid my co-pay on the day of the procedure I did notice that it had increased from $25 to $50.  I was told that my insurance coverage had changed, and that was the reason for the higher co-pay.  If I have to pay the $500 then theres nothing i can do, but I dont appreciate never recieving a bill.  What are the rules of billing, can they not send me a bill and then demand that I pay over the phone?  Or do I sense that the billing department has fouled up and someones trying to not fess up to their mistake.  Thanks to all who respond.

[Michele]

I would call your insurance company and ask them what your patient responsibility to the hospital was for that service.  If they say $50 (or $25) then I would ask if that hospital is in network with them.  If they are in network, they are breaking their contract with the insurance company by charging you more than the insurance company says they can.  The insurance company usually will investigate from that point.  You just need to find out if they are over charging you and then let the insurance company know it.

Michele

[avargas681]

Thank you for the quick reply.  Ive had the same procedure done at that hospital only a few months earlier and they are in network.  But now that I think about it, the increased co-pay, and the receptionist stating that my "coverage changed" might mean that they have fallen out of network.  Thanks again for the suggestion, i'm going to be looking into that today. 

[avargas681]

One more thing, how can they not send a bill, either electronic or paper?  Then call 6 months later demanding a phone payment or in their words "will go to collections after today".

[PMRNC]

Because they are just doing THEIR job, they are a third party to the provider. Next time they call, tell them you need an itemized bill or call the provider for one so that you can research this. Also request that the provider call off the collection agency until you have had time to review the bill.Also I would ask for the service date and call your insurance company, it might possibly be that they never received the bill or processed it..Take it from there once you get a bill. If it is past the timely filing limit then I would appeal with your carrier first, with the itemized bill and explain that the hospital is demanding payment in full. You will have better luck than the hospital will at this type of appeal.