Not a day goes by that I don't get one bill or another. I'm putting this out here to general forums because I don't think it happens only when a death has occurred.
Husband had insurance. He paid for it every month. A deductible had to be satisfied and then an out-of-pocket limit reached. Within six weeks he went from icu to rehab to alf to hospice. Each location had an assortment of docs, specialized servives, such as: intensivest services (?) neuro, psychneuro, cardiac (?) almost anything you can think of.
Now, the deductible has been reached the insurance company says the out of pocket has been reached and the bills getting more threatening- collection agency- garnishmnet, etc. He is deceased, what are they going to garnish?
Has anyone encountered this? They have been paid, each and every entity; not the billed charge but the insurance alloted charge. There were errors: transport service billed but then it was written off because there was an admit. ER initially billed and then cancelled it likewise because there was an admit "Indotrach" was charged despite a dni order and I have yet to get into that.
When a "subscriber" as they say has died do they write off or discount the charge? Each has been paid by insurance and now they want husband's share which of course he cannot pay.
I want to be honorable, contact them and inform them husband has died but am I shooting myself in the foot here?
I am not sure if I am explaining it correctly because i don't really understand it myself but still hope someone here can help.
Abby, I don't know the answer, but I would think some depends on the state you live in. In community the spouse is equally responsible I think. A consult with an attorney might be in order if you think that would help. Hospitals will try to make you pay no matter what.
Abby, I am dealing with the same problems. They do not care if he is dead or alive. They want their money. If it is the co-pays they want, I pay it. My current problem is DH's March hospital bills. Doctors I never heard of have been sending bills, Ins is denying. I have appealed everyone of them. They want you to give up and pay them. I will continue to appeal until they pay. What else do I have to do? I can't wait for the May bills to start. Anyway, I believe that you as his wife are libel for payment. You can get more info from his ins co, as to what is covered.
Abby: Did your husband have medicare? As I understand it, if a doctor, hospital accept medicare then regardless of what they charge they must accept medicare at total payment
If your husband didn't have medicare, then maybe you should contact your insurance company and ask for their advise and also ask them if they have the same clause as medicare...that being: If they (doctors hospital, etc.) accept your insurance and agree to what the insurance pays as full payment...then you won't owe anything. Other then that I don't know what your solution is.
Also, how old was your husband, maybe some social service agency can help you wade through this problem.
Abby--this is to elaborate on what Judith said--my insurance has "preferred providers" i.e., doctors and hospitals, who agree to accept what the insurance pays them. I think you need to go over his insurance policy--see if there's a website or printed material available and then contact the insurance company too. I wouldn't jump to pay anything beyond what the insurance did until you know the details. You may end up needing to contact an attorney to find out what you're legally responsible for and if it's significant, I'm wondering if you can cut a deal based on the extreme circumstances--it never hurts to ask.
You may need help, there are companies that specialize in sorting out medical bills. Be careful about paying anything you are unsure of, it might commit you to payment of the bills where otherwise you are not committed.
In the past I found doctors willing to accept what insurance paid and writing off the rest, but that was over 20 years ago.
Does the hospital have an ombudsman that can help.
And medical billing has a reputation for being error-filled.
And Ocallie36 is right, they want you to give up and pay them. They don't care if you or insurance should pay them, or if the bill is correct or anything else. They just want to get paid. Be aware of you rights as it comes to collection agencies and bill collectors, if they violate the law you do have recourse.
This is one of the things I appreciate most about this forum- put something out there and the responses are right there.
So much like what you have said. Bills from docs outside the system; despite poa I was never consulted about their participation. My husband was in isolation for most of his hospital stay. He could not communicate so I guess they did what they thought was best and I am going to start another thread on a topic, "intubation" that I need to know more about.
Charlotte, you are correct. I am in a community property state and have been told that while I am not personally responsible, the "estate" is. I don't understand it; like what Ocallie and Marilyn said, I almost wonder what is the point of insurance. I guess it could be worse, but they turn the numbers around and this can apply and this cannot, etc.
What has really been worse is SSA. Despite the fact that the people there have been nice- husband was approved for SSD quickly. But now that he has died- poof, it's gone. I think Marilyn has addressed this here, not her words but theirs "we have NO PROVISIONS for young widows".
A very nice analyst said that statistically I am an anomaly. A widow at such a young age, well, too bad for me. Apparently there are very few in my age range and even fewer who had a husband younger than they are. Also, I think as Marilyn referenced, they are fond of saying his allocation was the same as if he retired at age 66 and a fraction I don't recall.
However, I have from them projections of what the benefit would have been if he had continued to work, as he had hoped, at least until 62...more quarters, more income, more benefits. I just about lost it when the SSA rep said "he chose to retire at such an early age".
Like he chose any of this!
Judith, no, even with the SSD ruling medicare was more than a year in the future. I will ask insurance about that but so far they are sticking with "it is owed". My husband was 52.
First, have you appealed the claims on your husband? Is it past the time period to do so? Did you ever have a case manager at your health insurance company? Call them and see if they have one, and explain how his treatment was emergency and that you were not consulted and he couldn't respond and see if that helps. The Explanation of Benefits tells you what you owe and what the hospitals and doctors have to write off if they are "in network" providers.
It is important that claims be dealt with as soon as you receive your Explanation of Benefits where it shows what you owe and why. Then you can appeal and state why. Sometimes it will help reduce the amounts owing.
It is so sad that while we are so concerned about the emergency, life and death of our spouse, that we must also consider the immediate financial ramifications.
Anyone whose spouse is on Hospice should have a case manager from their health insurance company to see that they have everything taken care of for them. They will tell them what benefits they have that they might not know about, and will deal with the hospitals and doctors too, in some instances. They won't appeal past claims for you though, but they may offer you suggestions on how to proceed.
Good luck with trying to get those bills lowered! I wish I could help you more!
Abby, Mary and the others have given you good advise. I am a "retired" HR Director and even for me all the bills from hospitals, particularly the ER are confusing. I will try to help, but if you want to contact me let me know and I will be glad to help you through as much as I can.
Mary's right-you MUST open all Explanation of Benefits (EOB) statements immediately because there is a timelimit (depending on the insurance plan) within which you can appeal the claim (usually 60 days). Failure to submit an appeal within the time limits will then allow the charges to stand. I would check with the ins co and see if they had assigned a case manager to your husband's case and perhaps he/she can help.
It is important to know if the doctors who teated your husband were in or out of network and if the hospital where he was treated was in/out of network. If they were in network (meaning they have a contract with the ins co and will accept what the ins co pays) then it is against the law for those doctors to bill you for the portion of the bill the ins co didn't pay. If that's the case, notify the ins co immediately that they are billing you for the balance. You are not obligated to pay the balance, but many doctors will try. If they were out of network, then typically there's an out of network deductible (usually much higher than the in-network deductible) which has to be met before the plan will pay. In our case, the in net deductible is $1200/person, the out of net is $4500/person. Once the out of pocket maximum is met (which should include $$ you pay towards reaching the deductible) then all bills above that amount should be paid 100% by the ins co.
Most hospitals no longer run their ER's, they hire a company which specializes in running and staffing ERs and are a contracted service to the hospital. That's where I've seen bills from doctors and xray companies and other vendors that I had no idea they were providing services. Most likely they will be out of network but most ins co will pay the in net rate because you don't have an opportunity to say you only want an in net doctor. If you haven't received an itemized bill from the hospital and the ER service, then get one immediately and try to match the EOBs with the charges from the hospital.
You should also be aware of the ins co requirements for notification if a hospital admit happens from the ER. Our ins company requires notification with 48 hours of the hospital admission. Failure to notify within the required timeframe will most likely result in a decreased payment by the ins co for the hospital bills.
Perhaps it would be a good starting point to contact the benefit plan administrator and see if they can help you both understand the plan and what is/isn't covered.
Let me know if you want further assistance and I will contact you via email.
Hospice told me the ambulance ride from ALF to hospice would be "no charge" since she was being admitted,low an behold a few weeks later a bill for over$600,got tired of talking to them an finally just paid the #$%^ bill
A view from the other side. I have a relative who works for a medical clinic with about 300 employees in their accounting dept. Hours have been cut, workloads increased. They are implementing expensive new systems mandated by the new health care laws. I believe that, along with other medical providers, they are not greedy but are just trying to survive.
Edit to say: She works in accounting--not that they have 300 employees in accounting. Big difference. I need to go back to high school English class.
I confess that I never read the eob statements in detail. They said approved but didn't detail what exactly was approved. I let them pile up as I have done with other mail.
LFL, your explanation has helped so much, as did Mary*'s advice. My out of pocket is exclusive of deductible but your information gave me a much better idea than what I had before about what to ask of the insurance reps. In response they are sending me a detailed report of what is owed. I think the out of pocket is high but as the rep told me, and not unkindly, "this is the policy you purchased".
Lori, I didn't mean to imply that any rep is greedy. I can kind of tell from the wait times and the frequency of "beeps" as I speak with them how time constrained they must be. And then there is always that message about how the conversation is (maybe) being recorded. Many, if not most, have been very nice.
Nevertheless, there is profit, a great deal of profit in that system. I know we can't discuss politics here, but I sure don't think that profit is going to the call center employees.
abby, glad I could help. I didn't have a chance yesterday to email Joan with my email address, but I will today in case you have any other questions or I can direct you. Sounds like you have an insurance plan that is classified as a "high deductible plan"-with a high out of pocket limit. Typically the premiums are much lower than a plan with lower deductibles/out of pocket expenses. In essence, you are responsible for "insuring" your self for the first $5000 or so expenses before the plan begins to pay anything.
I can also tell you with certainity that all calls to the ins co are recorded. They do this to ensure there is a record of what was discussed on the call in case you challenge something they didn't pay. From personal experience I challenged a payment that wasn't made by the ins co and told them when I had called it to discuss it. They pulled the telephone call and sent me a copy of the transcript of the call. Don't forget to get itemized bills from all providers so you can match the bills and payments with the EOBs and the itemized list from the ins co.
I received the message from Joan but as far as I could tell, your email was not included. I caught your name (but no other identifying info) in her email to me and you may smile a bit when you see my email. I emailed her back but have not yet heard from her; when I do, I will email back to you.
Your last post is exact to what I have experienced. Considering H's condition there was only a choice of two plans. The one I chose, when we were in dire straits last year did have the higher deductible and out of pocket as you said.
Insurance, and they were really kind, advised me to contact by cetified mail outstanding billers; notifiy them of H's death and ask that insurance payments be accepted as payment in full. So, over the last few days I have done this with each and every one. No one was not paid, but no one was paid what they billed either. One "concern" was especially over the top. I'll see what the response may be.
EOB's used to detail what was billed-approved-paid-outstanding. No longer; they just said approved within limits. Okay. I can play, partly out of financial concerns, partly out of principle. Even if it comes to nothing I can (I hope) rest that I did my best! I spent the weekend responding to all their bills. Emotionally exhausting as some wanted me, no, required me to submit an affidavit that H and I were married, that he had no children (many seemed especially interested in that), and etc.
One provider, from whom I have not received any bill claimed to have provided service on a date at least two weeks after the death.
That one, and the bill was not large, but nevertheless, is on my short list to pursue.
I'm exhausted but maybe it is better to be busy...
Abby, my email is my first and last name with a hyphen between the two names @hotmail.com, so you may have gotten the email address from Joan and not realized that was the email address.
Good for you...I know it is emotionally exhausting to go thru all this but you don't want to ruin your credit rating going forward (they will come after you). I am glad the ins co has been helpful-I am wondering if legally they have to provide you with an EOB which details billed services, amounts paid, amounts due. I am sure the ins cos are also trying to cut costs but otherwise how would you know what was paid and what was due?
I also meant to tell you that should any bill collectors call trying to collect, they cannot call you after 9:00 pm. And, under NO circumstances should you agree to pay a portion of the outstanding bill because one you make a payment, you're on the hook for the whole outstanding balance.
They want to know if there are children so they can try to collect payment from them if you or jis estate does not pay them.
Yes, bill collectors will try anything. We have had them call us to try and collect what our son owes people. Fat chance. Makes me angry 1) they call us 2) how did they get our cell numbers? One way is son put us as next of kin with our phone number. So do not miss them in my life.
I just read an article about protecting yourself from bill collectors and lost the location. I had advice for how to review bill collector documents. Many times there are major errors. It was written for lawyers but useful for us. This is what I remember. This is for the US.
Ask for their state license. No license, don't pay them, they can't force anything.
Never make a partial payment, it commits you to the entire bill.
Make sure the names are correct and consistent on all documents. It is common for the collection agency to identify itself with different names on different documents. They don't match they cannot legally collect.
Bills can get sold more than once, they need to show an unbroken chain between themselves and the original billers.
Just as police says most criminals are not very smart and easy to catch, many bill collectors also seem to be not very smart.
I once lived with someone who had outstanding student loans. The lies told over the phone in order to try to confirm that this person was living in our house were amusing.