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Thread: A wrongful billing

  1. #1
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    pjohns's Avatar Senior Member
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    A wrongful billing

    My wife was in the hospital a few months ago, for knee-replacement surgery. Medicare, as usual, paid 80 percent of the adjusted charges.

    For the past several weeks, she has been bombarded with requests--no, demands--for the remaining 20 percent.

    The problem is that she has a Medigap policy--"Medico"--that pays 100 percent of what Medicare does not pay (unless Medicare denies the claim altogether).

    She has repeatedly asked the billing department at the hospital to contact Medico, and get the money from them.

    They have always apologized, and responded that they will do so.

    But they never do.

    It is as if the right hand does not know what the left hand is doing.

    If it were me, I would return the billing statement to them, with these words written on it:

    "I do not plan to pay this. Not this week. Not next week. Not next month. And not ever.

    "But if you will file with my secondary insurer, you will receive your money.

    "Thank you."

    This is beginning to get beyond the absurd stage...

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  3. #2
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    stjames1_53's Avatar Senior Member
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    Quote Originally Posted by pjohns View Post
    My wife was in the hospital a few months ago, for knee-replacement surgery. Medicare, as usual, paid 80 percent of the adjusted charges.

    For the past several weeks, she has been bombarded with requests--no, demands--for the remaining 20 percent.

    The problem is that she has a Medigap policy--"Medico"--that pays 100 percent of what Medicare does not pay (unless Medicare denies the claim altogether).

    She has repeatedly asked the billing department at the hospital to contact Medico, and get the money from them.

    They have always apologized, and responded that they will do so.

    But they never do.

    It is as if the right hand does not know what the left hand is doing.

    If it were me, I would return the billing statement to them, with these words written on it:

    "I do not plan to pay this. Not this week. Not next week. Not next month. And not ever.

    "But if you will file with my secondary insurer, you will receive your money.

    "Thank you."

    This is beginning to get beyond the absurd stage...
    ahhhhhhhhhhhh, the taint of red tape
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    FindersKeepers's Avatar Senior Member
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    Quote Originally Posted by stjames1_53 View Post
    ahhhhhhhhhhhh, the taint of red tape
    Incompetence in the billing department.

    Just to get the monkey off your back, make a copy of the invoice they sent you and forward it to you secondary insurer.
    ""A government which robs Peter to pay Paul can always depend on the support of Paul" ~George Bernard Shaw

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    Casey Jones's Avatar Senior Member
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    Quote Originally Posted by pjohns View Post
    My wife was in the hospital a few months ago, for knee-replacement surgery. Medicare, as usual, paid 80 percent of the adjusted charges.

    For the past several weeks, she has been bombarded with requests--no, demands--for the remaining 20 percent.

    The problem is that she has a Medigap policy--"Medico"--that pays 100 percent of what Medicare does not pay (unless Medicare denies the claim altogether).

    She has repeatedly asked the billing department at the hospital to contact Medico, and get the money from them.

    They have always apologized, and responded that they will do so.

    But they never do.

    It is as if the right hand does not know what the left hand is doing.

    If it were me, I would return the billing statement to them, with these words written on it:

    "I do not plan to pay this. Not this week. Not next week. Not next month. And not ever.

    "But if you will file with my secondary insurer, you will receive your money.

    "Thank you."

    This is beginning to get beyond the absurd stage...
    Might be time to contact a lawyer. Look to see if there's a low-cost legal clinic in your area.

    Typically they'll charge a couple hundred bucks to write a first cease-and-desist letter. That sounds outrageous, and it is - but if they don't cease and desist, he can follow through, and maybe also initiate punitive damage claims.

    But what a loy-yeh's letter does, is make it plain that you're not playing - and it will get it out of the hands of those useless mine-ore-itty clerks, and into the fingers of someone with actual authority. Who can then make it right.

    Or not, and that's when you start the lawsuits.

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    barb012's Avatar Senior Member
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    The things that we were able to rely on with people we do business with no longer exists. Those billing statements your wife is getting should be returned with, "you have our secondary ins information" since they pay the 20%, I will throw your statements in the trash this day forward.

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    Quote Originally Posted by pjohns View Post
    My wife was in the hospital a few months ago, for knee-replacement surgery. Medicare, as usual, paid 80 percent of the adjusted charges.

    For the past several weeks, she has been bombarded with requests--no, demands--for the remaining 20 percent.

    The problem is that she has a Medigap policy--"Medico"--that pays 100 percent of what Medicare does not pay (unless Medicare denies the claim altogether).

    She has repeatedly asked the billing department at the hospital to contact Medico, and get the money from them.

    They have always apologized, and responded that they will do so.

    But they never do.

    It is as if the right hand does not know what the left hand is doing.

    If it were me, I would return the billing statement to them, with these words written on it:

    "I do not plan to pay this. Not this week. Not next week. Not next month. And not ever.

    "But if you will file with my secondary insurer, you will receive your money.

    "Thank you."

    This is beginning to get beyond the absurd stage...
    The problem with that plan is the hospital will just sell the bill to a debt collector. Call Medigap and see if they can assist.
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  11. #7
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    Casey Jones's Avatar Senior Member
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    The hospital can still be held liable, as they sold the account as a valid debt when in fact it was not, and was being billed unlawfully.

    Punitive damages are to discourage/punish reckless misfeasance of this sort - a financial incentive to keep proper accounts.

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    Quote Originally Posted by pjohns View Post
    My wife was in the hospital a few months ago, for knee-replacement surgery. Medicare, as usual, paid 80 percent of the adjusted charges.

    For the past several weeks, she has been bombarded with requests--no, demands--for the remaining 20 percent.

    The problem is that she has a Medigap policy--"Medico"--that pays 100 percent of what Medicare does not pay (unless Medicare denies the claim altogether).

    She has repeatedly asked the billing department at the hospital to contact Medico, and get the money from them.

    They have always apologized, and responded that they will do so.

    But they never do.

    It is as if the right hand does not know what the left hand is doing.

    If it were me, I would return the billing statement to them, with these words written on it:

    "I do not plan to pay this. Not this week. Not next week. Not next month. And not ever.

    "But if you will file with my secondary insurer, you will receive your money.

    "Thank you."

    This is beginning to get beyond the absurd stage...
    Doesn't Medico send you a statement of what they paid?

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    Quote Originally Posted by pjohns View Post
    My wife was in the hospital a few months ago, for knee-replacement surgery. Medicare, as usual, paid 80 percent of the adjusted charges.

    For the past several weeks, she has been bombarded with requests--no, demands--for the remaining 20 percent.

    The problem is that she has a Medigap policy--"Medico"--that pays 100 percent of what Medicare does not pay (unless Medicare denies the claim altogether).

    She has repeatedly asked the billing department at the hospital to contact Medico, and get the money from them.

    They have always apologized, and responded that they will do so.

    But they never do.

    It is as if the right hand does not know what the left hand is doing.

    If it were me, I would return the billing statement to them, with these words written on it:

    "I do not plan to pay this. Not this week. Not next week. Not next month. And not ever.

    "But if you will file with my secondary insurer, you will receive your money.

    "Thank you."

    This is beginning to get beyond the absurd stage...
    Have you contacted Medico to determine whether a claim has been filed?
    In quoting my post, you affirm and agree that you have not been goaded, provoked, emotionally manipulated or otherwise coerced into responding.



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    Calypso Jones's Avatar Banned
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    THat happened to me too...is it too out there to think that perhaps..PERHAPS someone in the billing department is skimming this money when someone is paying in addition to their insurance?

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