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More Questions About Hospital Bills

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Latest post Mon, Jan 18 2016 9:31 AM by ca19lawyer2. 2 replies.
  • Mon, Jan 18 2016 1:34 AM

    More Questions About Hospital Bills

    This is still related to an auto accident my elderly Mom had last summer.

    Now she is getting lots of Explanation of Benefits forms.  She was taken to one hospital first and then transferred to a regional trauma center.  The bills from the first hospital, where she only was for a few hours before being transferred, seemed amazingly high.  I had her ask for an itemized bill.

    There are things on the itemized bill that seem implausible.  E.g., 3 CAT scans.  She says she had no CAT scans at that first hospital.   I wasn't there yet so I have no clue whether she had any CAT scans or not.  But it seems implausible that she had 3 CAT scans in the short time she was there, along with everything else they billed her for. (xrays, IVs, consultations, treatments, referrals, even facial tissues and disposable utensils - really?  She wasn't admitted and she didn't eat any meals there.)

    But those 3 CAT scans really seems wrong especially since she said she didn't have any CAT scans there.  Do they have to prove that she had CAT scans if they are charging her for CAT scans or is the burden of proof on her to prove that she didn't if she doesn't think she should have to pay for them (actually its Medicare that is paying for them, but she thinks they shouldn't because she is sure she didn't have those CAT scans)?

    She also said that her insurance company paid a $36,000 claim for the other driver's car.  I don't understand that since her insurance company said she was only 51% at fault.  Does that mean that $36,000 was 51% of the value of the other driver's car?  That must have been some car!  I thought the other driver's car, the one in front of her, wasn't even damaged.

  • Mon, Jan 18 2016 5:42 AM In reply to

    Re: More Questions About Hospital Bills

    LegalSecy:
    along with everything else they billed her for. (xrays, IVs, consultations, treatments, referrals, even facial tissues and disposable utensils - really?  She wasn't admitted and she didn't eat any meals there.)

    Sadly some hospitals itemize bill everything from cotton balls to major surgical supplies this way.  While she may not have been brought a meal tray if they got her jello and gave her a spoon = bill.  I don't agree with this but they do it.

    LegalSecy:
    But those 3 CAT scans really seems wrong especially since she said she didn't have any CAT scans there.

    It isn't uncommon to have a CT of the head and at least abdomen following a car accident to ensure there is no bleeding.  They take a few minutes so Mom may not remember them even doing it.  What she can do is sign a HIPAA release and request copies of the results.  If the hospital can't produce them then you can file a dispute about being billed for care/items she didn't receive.  

    "That's just my opinion, then again I might be wrong."  Dennis Miller

     

  • Mon, Jan 18 2016 9:31 AM In reply to

    Re: More Questions About Hospital Bills

    LegalSecy:
    Do they have to prove that she had CAT scans if they are charging her for CAT scans or is the burden of proof on her to prove that she didn't if she doesn't think she should have to pay for them (actually its Medicare that is paying for them, but she thinks they shouldn't because she is sure she didn't have those CAT scans)?

    There's no "burden of proof."  This is simply a billing situation no different than hundreds of other similar situations that a person might encounter (except that an EOB is not a bill, and the hospital is apparently billing your mother's insurer instead of her).  If the EOB contain errors, your mother can (and may have a duty under her policy to) contact the insurer.

     

    LegalSecy:
    She also said that her insurance company paid a $36,000 claim for the other driver's car.  I don't understand that since her insurance company said she was only 51% at fault.  Does that mean that $36,000 was 51% of the value of the other driver's car?  That must have been some car!  I thought the other driver's car, the one in front of her, wasn't even damaged.

    $70,000 cars are not common (which is what the approximately value would be if $36k is 51% of its value), but they're hardly rare either.  In any event, your mother is free to call her insurer and seek additional information about it's payment of the claim.

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