2

Some months ago, I received treatment at a hospital in New York City. While I was there, I provided them with the insurance information for two plans under which I was covered.

Company A sent me an explanation of benefits with submitted charges that total to ~$7000, of which they paid ~$3000. Company B later sent me their own EOB that shows the same charges for the same amounts, of which they paid ~$1000. Both EOBs say that I am responsible for a much smaller amount, though this amount differs between the two companies.

Given that the submitted charges to each company are identical, it seems that the hospital erroneously billed both plans as primary, whereas I had indicated primary and secondary when I furnished the plan information. My understanding--now called into question--has been that the primary plan covers such as it will, then the secondary plan determines what it will cover from among the services not covered by the primary or covers the co-pay from the primary.

When I received a bill from the hospital for Company B's co-pay, I called the hospital to ask about the possible billing mistake. However, the hospital only told me that Company A had amended their coverage and I should take things up with the insurance companies. But on Company A's website, the EOB has not changed, even in the two months since said phone call. I haven't received any updated EOBs in the mail or otherwise. Company B confirmed that they paid as primary and have no knowledge that Company A was in any way involved. I have not received any bills connected with Company A, nor have I paid anyone thus far.

The day after my initial phone call, I mailed a response to the hospital suggesting that, since they received a greater total payment from the two companies than they would have received under either plan by itself, that I should not be liable for any additional amount. However, I have not received any indication that this letter was received or read. I plan to call the hospital again at the next opportunity.

In Summary

(1) Should both plans have been billed identically, or was there a mistake that I should seek to have corrected? My best guess is that the hospital does not realize that Company A's payment is on my behalf.

(2) If I pay the bill connected with company B and demand/receive confirmation of "paid in full" status, will I be in the clear with regard to any supposed bills connected with company A?

(3) If I inform company A about the (possible) incorrect billing and they rescind their payment, will the hospital have any grounds to come after me for the amount taken?

0

1 Answer 1

3

After a number of phone calls, I have learned that Company B incorrectly paid as primary: they received information about Company A's payment and completely ignored it. The hospital has updated my account to show that I them owe nothing.

This, of course, is the result for my particular case. Others may have different circumstances, even in apparently similar cases.

Your Answer

By clicking “Post Your Answer”, you agree to our terms of service, privacy policy and cookie policy

Not the answer you're looking for? Browse other questions tagged or ask your own question.