Surprise bill after surgery- Advice needed

[erik78 79]

My sleeve was done on 4/14. The week prior to my surgery I still had not been told what my responsibility was. I knew my deductible was met and that I had a max 10,000 benefit for the surgery. After several calls the surgeon called me and said my responsibility was 400 with them. The hospital finally called me 2 days prior and said my responsibility was 1100 and that was owed immediately. I paid that day..... 3 months later, yesterday I received a bill for 9,300. On My first call to hospital billing, the rep said I had a 10,000 maximum and so Humana only paid partially. And they wanted me to pay the rest. I said then why didn't they apply that when they called me to take my payment in full. The rep started getting pissy, and said that it was my responsibility to give the insurance coordinator all my info. I replied that's your job to verify my coverage, don't you want to get paid! He then said well sometimes we don't verify your full coverage until several weeks after surgery. Its been escalated now to a supervisor. I called Humana and they said that the most likely scenario is that the insurance coordinator missed that I had. 10,000 max when she told me my estimated out of pocket and took my payment. She obviously had my info and that's why she was able to figure out that I owed 1,100. She just missed the most important part. I had no idea what the hospital charged and what my insurers negotiated rate is that's why I never questioned the amount they said I owed. I also work for Humana and understand how insurance verification works. I assumed they did their job. Has anyone had a similar experience. How was it resolved. Thanks.

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[Wolfgirl78 266]

Unfortunately if you owe it, you owe it even if someone else made a mistake and didn't charge you prior to surgery.

My advice is to try to make payment arrangements with the hospital as to a monthly amount they want sent.

Good luck

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[theantichick 2,204]

Having worked for a hospital in the past, I can also tell you that if you escalate to Administration, they have a lot of leeway in reducing the bill.

[OutsideMatchInside 10,166]

Escalate it and complain as much as you can to try and get them to reduce it. Then agree to a payment plan.

[AvaFern 3,516]

If you want to be creative you can use the phrase "informed consent". When you consented to surgery, you agreed to the surgery based upon an understanding of what your financial responsibility would be. If you had been told that you would owe almost 10K, you would not have had the surgery and you would not have provided consent. As such, they did not fully educate you about all aspects of the surgery, which the cost is included in that, thus you did not provide fully "informed" consent, which makes the procedure illegal.

If they performed surgery without providing fully informed consent, which a good attorney can argue includes the cost that you would need to pay, they have a much bigger problem to worry about than your bill.

[erik78 79]

Thanks for all the advice. Very helpful. I'm going to wait patiently for their response.

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