r/HospitalBills • u/TiredMom57 • 4d ago

Unwarranted charges

Has anyone gone as far as making a written complaint to the CEO, CFO, Board of Trustees, and or the entity that accredits a hospital for charges that are fraudulent? My case:

My husband had a mental crisis in February ’25. He had a hospital stay for 2 weeks in the psych ward at a hospital that our doctors are affiliated with. Upon his discharge, he was offered to enroll in an IOP program depending on insurance coverage. I distinctly remember having to wait for word that his enrollment would be covered under his insurance. It was and he began the Monday after his hospital discharge. We were told point blank “the program is approved”.

During the 6 months he’s been attending this program, he was forced to have a 1:1 therapy session with a designated therapist. This was supposed to happen once a month. There was no canceling on these sessions. About April, we started getting EOB’s from his then insurance stating that they would not cover 2 therapy sessions on the same day. So right now, he has an extra therapy charge for each month and 2 months, they forced 2 sessions in those months.

I have called the business office complaining that this is not fair. One of the reps there sent an email to the person who is over the IOP program to call me and I have not received a call yet. That was in May. I just called again and got the name of this person and it happens to be the Director of Social Services for the hospital and this program. I have her email bc I’ve had to contact her about a number of issues with this program.

I made up my mind that I am not paying a cent towards his balance until this is addressed.

Incidentally, there are other issues that I need to address that haven’t set well with us about this program. Unfortunately, there’s no other program in the town where we live so this hospital has a monopoly over people with mental illness.

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u/Odd_Construction_269 4d ago

THIS IS NOT LEGAL ADVICE

…. The hospital CEO is there to protect the hospital, not you.

I’d actually complain directly to your insurance. If your insurance lets the hospital know they billed for services not incurred, the ceo gets that memo and will freak at the idea of losing a payer contract.

Signed, Manager in hospital network who is aware internally of how these conversations go and how payer contracts work and how hospital leaders freak out at the idea of fraud against a payer.

AGAIN, not legal advice. I’m just in the environment enough to understand the conversations and what gets hospitals to pay attention.

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u/TiredMom57 4d ago

Thank you!

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u/TiredMom57 4d ago

Sadly, he was covered by BlueCross for about half of this time period. His company dropped him on 6/30/25 bc he’s on LTD. Even more sad is that his present insurance is Medicare with Cigna as a supplement. Still not paying. We have all the big toys we need to finance being 68 yrs old. So if it’s turned in to credit bureaus, so what!

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u/Odd_Construction_269 4d ago

Reach out to Medicare- they take fraud seriously. I’d also reach out to the supplemental coverage carrier.

Anyone who’s not you that’s paying on that needs to be brought into the claim that you’re being billed for services you didn’t receive.

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u/TiredMom57 4d ago

Will do that

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u/positivelycat 4d ago

You got a care issue which resulted in a bill. It's good that billing got you to that care area they are who needs to respond and adjust balance..

Do they have a patient advocate?

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u/TiredMom57 4d ago

Yes, there is a patient advocate for the hospital but I called her about another problem and she didn’t return my call.