r/HealthInsurance • u/shibesanon • Oct 12 '24

Employer/COBRA Insurance Anthem denied every part of my emergency surgery.

EDIT: I am getting this taken care of. THANK YOU TO EVERYONE WHO GAVE ADVICE

August 20th/21st I had to have emergency surgery on my lower intestines. Removing 6 inches and being stuck in the hospital for 5 days. The surgery caused my intestines to stop working for two days. I was supposed to stay in longer/not go to work. But I ended up leaving on the 25th and returning to work the 1st. And yesterday I got billed over 123k. With anthem refusing to pay a single dime.

I don’t even know where to go from here. I’m just lost.

I make less than 35k a year… how the fuck am I supposed to pay that?

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264

u/huntman21015 Oct 12 '24

Relax. This is common and usually is because they need more information from the hospital. You say you were billed $123k. Did you get a bill from the hospital or just an EOB from the insurance company saying you may owe that amount.

Even if your insurance pays none of it, which is very unlikely, your income would be under 400% of the poverty limit and likely qualify you for charity care from the hospital that would dramatically lower your responsibility. Take a deep breath.

52

u/mqrss3 Oct 12 '24

Seconding this. 1st ER visit they didn't tell me about financial aid. Ended up paying debt collectors 2k 2 years later.

2nd ER visit at another hospital - they told me about financial aid. With insurance, owed $1k... filled out financial aid and paid $0.

Very likely could've saved the 2k but AdventHealth can go fly a kite and I hate them for it.

5

u/loudifu Oct 13 '24

Was it the billing dept of the 2nd hospital who told you about the financial aid option? So many people dropped the ball on your first visit.

3

u/mqrss3 Oct 13 '24

To answer your question, no. Was told about financial aid immediately upon discharge, when I had to sign paperwork.

Long story if you care:

During intake at AdventHealth, the nurse went through normal Terms and Conditions, asked for a ‘deposit’ up front --- “usually $200”, I was like sure, I’ll put down $300. I’ll admit, I wasn’t fully functioning due to COVID and passing out multiple times but I’m pretty sure they didn’t go out of there way to say “hey, you likely will qualify for financial aid if you make under X”

Upon discharge, they were all “you should be fine, here are your papers. Have a nice day”

That was that. Month goes by, I start getting the bills. I read online how devastating medical bills could be, so I called and asked to speak with billing, to see if I could haggle the price down. “Best we can do is 20% off, if you pay in full. Otherwise we offer payment plans”

Checked their website regarding financial aid. Stated they only helped people at or below the poverty limit. I definitely pass the poverty limit, so I didn’t apply or ask.

I tried twice regarding lowering the payment, they wouldn’t budge. “OK, please send to collections then.” Well, I just ignored all letters and calls until it eventually went to collections. Took 9 months.

Collections called every single day, at least 1x a day for about 1.5 years. I messed up one day while waiting on a person and picked up one of the collector’s calls. Had to haggle down from that ledge.

New ER just recently for abdominal pain (ultimately due to medication) ---

Upon discharge, I was complaining about how the other hospital sucks and wanted to see what the bill would be. The lady up front was very nice and threw out financial aid. I was like…. I don’t think I qualify, I make more than the poverty level from AdventHealth. She says “Doesn't surprise me. I used to work there and they wanted people to pay as much as possible. You’d be surprised at who is eligible for financial aid here. Please fill out the form and we can take a look.” I gave it a whirl. After she saw my gross income on the form, she states “if you make less than 100k in this city, you likely will get financial aid.” I was FLOORED. I still saved up the $1.2k estimated bill but when they digitally sent me the bill, I saw a ‘discount’ for financial aid. So I owed nothing.

I **JUST** received a letter in the mail about a bill from the same ER visit. I need to call and confirm, maybe this was just a delayed bill mailer that doesn’t consider the financial aid. Regardless of the outcome - Maybe I don’t owe $0, but sure as heck beats $900!

1

u/loudifu Oct 14 '24

Wow! So, that 2nd hospital lady pretty much admits that the other hospital she used to work for just outright lies about the "poverty limit"? Or, is it simply there's a lesser known higher limit (specifically for the city) that many hospitals are not aware of?

P. S. I ve read that in SF if you make less than $250k a year, you are eligible for some form of financial aids on purchasing a new home!!

2

u/mqrss3 Oct 14 '24

No, there wasn't a lie about poverty limit or anything of the sort.
The higher limit may be per hospital or simply has gone up due to cost of living/inflation.

AdventHealth supposedly pushes people to pay as much as possible before leaving. That is what health professionals are trained to do. A minimum of $200, more is better. That's what the lady told me at the 2nd ER hospital.

Any time anyone says financial aid, I've always said roughly the same thing: "I don't believe I qualify because I make over the poverty limit." AdventHealth likely mentioned financial aid at least once (when I was on the phone trying to haggle), but they sure as hell didn't go out of their way to push for it.
I know that UNLESS I got a bonus for getting people to pay (which I suspect is the issue here) - I would always lead with "if you make less than X, you likely will qualify for financial aid."
Hell, even if I can't say the amount, I would heavily push people to apply. That's way easier than arguing with people to pay. But that's just me. (Also probably why I'm not working in collections lol)

At the 2nd ER hospital, I said the same thing, but the lady told me "you should still apply anyways, you would be surprised." That last statement pushed me to do it. 100k is a lot of money and I would wager most people DON'T make that amount in any large city, let alone a large part of the country.

And yes -- some parts of California, HUD subsidized housing is available if you make 6 figs because that's how expensive housing is. Depends on how expensive the area is, but this info was from a few years back. I would imagine the number has gone up since then.

3

u/Distribution-Radiant Oct 13 '24 edited Oct 13 '24

HCA covered a 75k bill for me. And that's just the hospital charges - many of their associated doctors have an agreement (or did back then) to waive charges if HCA approves you for financial aid.

The non-profit hospitals have been hard to work with, in my own experience (Baylor and Ascension for reference). The best/worst part is I worked for Ascension at the time of my last hospitalization. They couldn't care less, I got fired while laying in a hospital bed at the same facility I worked at. They weren't willing to come up to my room to fire me to my face, despite being all of 1000 ft (at most) away from me. 🙄

At least medical collections don't hit your credit too hard these days. Baylor is considerably easier to work with, but still a lot of red tape. Ascension is a pain.

The best/worst part is I can't pay a hospital bill to my own (former) employer barely paying me enough for gas to get to/from work. At least they didn't pull anything like trying to garnish my last check. Sorry I had a heart attack while at work. EVERY LITTLE THING is contracted out with them, so it's death by 1000 papercuts over about a year of opening random bills, even an ambulance bill since paramedics were asked to respond. Like FFS just roll me into the ER that's 50 ft away. Pretty sure an ER doc is better equipped to handle a heart attack vs (admittedly very good) EMS.

2

u/mmw2848 Oct 14 '24

ProPublica has done a lot of articles about various non profit systems that have aggressive debt collection practices/limited financial aid. I'd honestly suggest reaching out to them - their series got Methodist in Memphis to drop the vast majority of their debt collection lawsuits and reform their policies. I think it's also raised some political alarm bells around non profit hospitals acting this way - they are supposed to have robust charity care.

1

u/mqrss3 Oct 13 '24

I know two examples aren't enough to be statistically significant, but I think if I ever can make the choice, I will NEVER go to a 'non profit' hospital for ER services. Seems interesting a 'non profit' can't (or won't) be able to be charitable enough with their financial aid even though they get tax breaks for being a non profit...

1

u/PoopyMcDoodypants Oct 14 '24

Fired while a patient at that facility. Despicable.

1

u/Distribution-Radiant Oct 14 '24

And I will never stop trash talking Ascension over that. My NDA has expired, they deserve all of the hate they can get.

1

u/Turbulent-Pay1150 Oct 24 '24

At most facilities non profit means the entity fleeces non MD employees and pays the least with the exception of executives.  Of course MD’s make bank as they will usually either be contracted or work for a for profit entity that contracts with the not for profit facility. It’s truly a ‘starve the janitor and nurses while the docs and execs eat cake’ is my observation. 

42

u/clarec424 Oct 12 '24

Have my upvote and I will confirm. Chances are very good that somewhere on that bill it should say insurance has been billed. Second, do you actually have an EOB from Anthem denying the charges? No EOB, call the hospital/billing office and ask if they have submitted a billing request to submit a claim. Good luck, OP.

10

u/Snarkonum_revelio Oct 12 '24

OP can and should also ask both their insurance and the health system for the detailed remittance codes - the only one(s) that can actually be billed to OP are those that start with PR. Anything else is part of the contract between the hospital and insurance company.

OP should also review to see if the codes were denied for out of network - health systems have been required to notify patients of any part of their services considered out of network (including in the ED after they stabilize), and if they didn’t get patient signature, OP is responsible for none of the out of network portion.

Finally, you’re correct that OP will qualify for charity care, but it’s likely that the health system is appealing the denial with the insurance company. If they do apply for charity care, they need to keep up with any requested paperwork or they’ll close the case.

3

u/[deleted] Oct 12 '24

I second this. You might’ve gotten a bill, but I’m sure it’s pending insurance review. The facility will appeal and the appeal process can take up to 12 months depending on the contract. I would not make any payments until you receive something like an EOB and focus on the PR portion. Save everything that you get from Anthem and the hospital as well as take detailed notes of anyone you spoke with, when you spoke with them and what they said when you called. When reaching out to Anthem, be sure to get the call reference ID number and jot that down with your notes.

Also be aware you will receive in most cases a separate bill for the ER MD, the surgeon and anesthesia services. Those are not usually included in the hospital bill.

19

u/HealthcareHamlet Oct 12 '24

Yes calm first, call your insurance company ask about the member liability and find out the reasons for it. They should also be able to suggest options for going forward.

2

u/Fun_Wishbone3771 Oct 12 '24

This. I can’t tell you how many times the hospital kept sending the bill to insurance with the wrong information- like my name or DOB. I got a bill for two year because of this.

2

u/userhwon Oct 13 '24

This should be explained on the way in. The panic from financial stress probably kills people before they even see a doctor.

1

u/cheestaysfly Oct 12 '24

What's an EOB?

3

u/Commander-of-ducks Oct 13 '24

Never pay any medical before you've seen your EOB. Compare the bill to what's in the EOB.

2

u/galaxystarsmoon Oct 12 '24

Explanation of benefits.

2

u/the_owlyn Oct 17 '24

Explanation Of Benefits.

2

u/Laura___Jean Oct 17 '24

The explanation of benefits from the insurance company tells you how much the provider billed for, and then gives you the breakdown of how much they need to write off, how much the insurance is going to pay, and how much you should pay for the service.

1

u/cheestaysfly Oct 18 '24

Oh thank you for the explanation!

1

u/MollyKule Oct 12 '24

Yep. My $16,000 ECV was also denied but I never owed a dime because they just needed to resubmit

1

u/naivemetaphysics Oct 13 '24

I was billed by the hospital for the full amount for having my kid. Then the insurance finally got the bill and I was changed $500. I wish I could upvote this comment more.

1

u/Lopsided-Shallot-124 Oct 15 '24

Agreed. I was once billed over 30k for an emergency surgery for my child. I fought with the insurance and my bill luckily got down to zero (took about a year). You have time before you have to take any bill too seriously even though it can feel like a real punch to the gut. Just keep fighting the insurance company.

-2

u/[deleted] Oct 13 '24

[deleted]

2

u/Imaginary_Manner_556 Oct 13 '24

That is exactly the right advice. Relax

-20

u/[deleted] Oct 12 '24

[removed] — view removed comment

13

u/Stunning-Ad6049 Oct 12 '24

Lol what? There's too much information missing regarding what OP was billed for, but you are very confused. Insurance denies claims for procedures all the time.

-11

u/[deleted] Oct 12 '24

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8

u/Mammoth-Routine1331 Oct 12 '24

You sound like you need therapy, and I hope your insurance will cover your mental health needs. Life is too short to be so toxic. 

7

u/Snarkonum_revelio Oct 12 '24

OP isn’t claiming they denied his care in that they stopped the surgery from happening (which they could never do no matter what because the hospital has to follow a whole host of laws about it), they’re claiming they denied the claim. I’m not even sure where in OPs post or the comment you replied to you got that impression.

Confused Accountant indeed.

4

u/Upbeat_Simple_2499 Oct 12 '24

Wow, you're really assuming bad intentions on the part of OP.

Just take a second and think: They've been through a traumatic experience and may have never dealt with something like this... the sudden hospitalization, the sudden surgery, bad health news, how their life is going to be impacted by this, other ppls bad stories of struggles with insurance or coverage, what happens if it happens again, living with fear that wasn't there before, and THEN they get hit with an insurmountable bill.

Yes they are overreacting but they just need a little guidance on next steps and how to play the game.

2

u/[deleted] Oct 12 '24

You literally say “no health insurance company can deny a procedure.”

2

u/HealthInsurance-ModTeam Oct 12 '24

Please be kind to one another, we want our subreddit to be a welcoming place for all

1

u/cheestaysfly Oct 12 '24

How the fuck are you an accountant and don't understand this?

5

u/Spallanzani333 Oct 12 '24

They can deny coverage for a procedure...... that's clearly what OP meant since he had the procedure done and then got a giant bill. You're taking this very personally, are you an insurance exec?

5

u/GailaMonster Oct 12 '24

Stop simping for big companies that absolutely deny necessary/covered procedures all the damn time.

1

u/Stunning-Ad6049 Oct 12 '24

Same response for you, lol what? Who's simping? That's exactly what I said. Some of ya'll really struggle with reading comprehension.

2

u/[deleted] Oct 12 '24

I’m pretty sure the “stop simping” comment wasn’t meant for you. Thats how it reads at least 🤷🏼‍♀️

2

u/aerynea Oct 12 '24

Denied in this context means insurance did not pay, not that the provider didn't do the surgery.

-1

u/[deleted] Oct 12 '24

[removed] — view removed comment

3

u/Imsortofok Oct 12 '24

You are being a willfullly literate. Are you genZ?

It’s obvious from context OP is referring to a claim fur a surgery already performed.

2

u/aerynea Oct 12 '24

OP never said that anywhere. They said insurance denied the CLAIMS after the surgery was done.

2

u/kaki024 Oct 12 '24

That’s the wildest straw man argument I’ve seen in a long time.

1

u/HealthInsurance-ModTeam Oct 12 '24

Please be kind to one another, we want our subreddit to be a welcoming place for all

1

u/cheestaysfly Oct 12 '24

You are confused. You can still get the surgery, they just are refusing to pay for it (currently). Insurance can absolutely deny procedures, but that is AFTER it's already been done, generally.

1

u/HealthInsurance-ModTeam Oct 12 '24

Please be kind to one another, we want our subreddit to be a welcoming place for all