Hello,

I wanted to see if you could kindly help me with regard to two bills I have received from a collection agency. Any assistance you can provide would be deeply appreciated.

I owe money for medical services since I went to the hospital�s emergency room twice for heart problems.

I stayed at the emergency room/hospital for about 4 hours or so the first time, and I stayed at the hospital overnight for observation on the second visit.

The original hospital bill was about $8,000.

I have health insurance through Anthem Blue Cross and apparently the insurance plan covered about $3,500 of the bill.

However, the collection agency claims that I am responsible for about $4,500.

Since I was taking care of my mother who is 88 years old, suffers from cancer and recently had heart surgery, unfortunately, I didn�t contact Blue Cross to understand how much of the bill they should have paid, and I did not contact the hospital to see if they would accept some sort of payment arrangement so I could pay the amount I owe in affordable installments.

Unfortunately, except for the last 2 years, I�ve never had health insurance before so I�m having trouble understanding the terms of my health insurance plan.

I believe I have already met my $1,000 deductible and a large portion of my out-of-pocket maximum this year, so I think that a larger portion of the approximately $8,000 bill should have been paid by Blue Cross.

I also can�t understand the bill sent by the Collection Agency, since the amounts listed by the collection agency do not correspond to the amounts that were billed by the hospital even after taking into account the portions that were paid by Blue Cross.

The bill that was sent by the hospital shows a lump sum amount rather than a breakdown of the specific medical services they provided.

Would it be wise to ask the collection agency to send me a bill from the hospital that breaks down the amount they�ve billed to show how much they charged for the x-rays, how much they charged for the EKG, how much they charged for blood draws, etc. while I was at the hospital?

Perhaps that way I could develop some understanding as to how they came up with the large lump sum amount.

The hospital�s charges appear to be very high. The amounts charged appear to be beyond what is customary and reasonable.

Are there any price controls or regulations regarding the amounts hospitals and medical service providers can charge?

I would imagine there should be some set fees that govern the amount hospitals and clinics can charge for medical services. Or can hospitals and medical clinics charge whatever they like?

Apparently, Blue Cross has a Negotiated Fee Rate (Pre-negotiated Discounted Fee) agreement with the hospital

Can I request a copy of the Negotiated Fee Rate? I believe that perhaps by reviewing the Negotiated Fee Rates, I can develop some understanding regarding the charges and payments that were made (and not made) by Blue Cross.

What are the chances of getting the collection agency to agree to accept a lower amount than what they are demanding right now?

Would they agree to payment arrangements so that I can pay the amount due in affordable installments?

I would be deeply grateful if you could give me any advice, information and ideas regarding how I could handle this issue.

Thank you very much for your kind attention and time! I greatly appreciate your help!

Tom

If the hospital has an arrangement with Blue Cross, the hospital is suppose to accept what they are paid. The bill can be outrageous but still if the insurance company has a signed agreement with them, they HAVE to accept it.
Now that does not mean the hospital will not try to get it from you; they are unscrupulous, to say the least. And they might go so far as to send it to collection because we all know how scary they can be. The point it whether wrong or not, they do it because there is a percentage that will not want credit rating to be hurt and pay it. Or worse yet elderly are known to pay bills just because they want no one thinking they cannot pay their bills. I had a mother-in-law that would pay anything sent her. We had to put a stop to it
What you need to do is simply call up Blue Cross tell them the exact dates so they can pull it up. Ask them if there was anything billed to you. It may have been part of deductible that is it or a copay if you have one.
If you have your original notice Blue Cross sent you, they always send you notice of payment to the hospital, it will show how much was charged, what was allowed [that's the agreed upon amount with the hospital] and if there is something you owe it will be in the next column. If it says you owe nothing - you owe nothing. If that is the case, tell the insurance company what they are doing, they have a binding agreement with the hospital and let Blue Cross attorneys handle it.