r/HospitalBills • u/TiredMom57 • 5d 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/TiredMom57 4d ago

Appropriate?….Anyone who’s been in my situation.

So I called billing yesterday, again, and the lady said she was emailing the person over IOP, again. I made a bet with the billing rep that the person she was emailing, a 2nd time, would not call me this time just like she didn’t call me the first time she emailed her. Wanna make that bet? I’m giving her til Tuesday to call me.

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u/DCRBftw 4d ago

I don't care enough to bet. I just know I'd try something different if I was dissatisfied with the results. I told you what I would do, but it seems like you'd rather repeat yourself and complain than to listen. So best of luck. Hope you get it sorted.

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u/TiredMom57 4d ago

As a matter of fact, I have reread your comments and don’t see where you’ve said what you would do.

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u/DCRBftw 4d ago

"Your best bet is to get in touch with insurance to find out why they're denying and then get in touch with someone in person to find out why they're billing incorrectly".

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u/TiredMom57 4d ago

I was looking for a statement that began “what I would do”. The hospital run IOP knows that insurance companies won’t cover this charge, but they make patients have the extra therapy session anyway. That’s not fair.

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u/DCRBftw 4d ago

They can't make patients do anything for outpatient. But again... your best bet is to speak with someone in person and explain that they're billing for 2 a day when insurance only covers one.

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u/TiredMom57 4d ago

Can you please clarify "they can't make patients do anything for outpatient"?

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u/DCRBftw 4d ago

It's outpatient. He's not on a psych hold. It's optional. He can leave any time he wants. He can choose to not participate and schedule his own therapy sessions.

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u/TiredMom57 4d ago

I know why it’s not being covered. The charge is for a 2nd therapy session in the same day as another that’s been charged. His previous insurance company didn’t allow that. Neither Medicare nor his supplement allows that. The hospital run IOP knows this but has the extra therapy session as a mandatory part of the program.

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u/DCRBftw 4d ago

If you aren't able to resolve it by speaking to someone in person, I would leave that program and schedule his therapy yourselves. Unless he's court ordered to be in that specific IOP, he's not required to be there.

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u/TiredMom57 4d ago

His last day is Friday. That's not the issue.

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u/DCRBftw 4d ago

But he's continued to attend sessions for 3 plus months and you knew this was an issue. You made one phone call in May and let this go on. Now you want to complain to the CEO. Do you see the problem with that? If it's been solved going forward, great. But I'm not sure what happened for the last 3 months where you guys continued to participate knowing it was an issue.

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u/TiredMom57 4d ago

If there was another program like this in town, trust me, he would’ve left a long time ago. We live in a small town with not many options for mental health.

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u/DCRBftw 4d ago

There are no other therapists? Only the ones affiliated with the IOP program?

I just don't understand how you knew this was an issue, but he kept going to two sessions a day when you knew you were being billed for the second session and all you did was make one phone call. It's baffling. It almost sounds like you wanted to wait until it was over so you could then complain in hopes of not having to pay. It makes no sense at all. What did you think was going to change? June, July, and August all passed and you just ignored the situation.

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u/TiredMom57 4d ago

The 2nd session was only once a month and it was mandatory for the program.

I think I’ve figured it out. Thanks for your help

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