Monday, January 30, 2006

Headaches and Hassles

I got a bill from the hospital in the mail on Saturday for over $17,000.00 for Holland's stay in the NICU, A YEAR AND A HALF AGO!!!!! This is out of the clear blue sky. I checked on it today, and it seems that our insurance company did an audit. They took back the total amount paid, then repaid all except for $16,000 which is now supposedly our responsibility. I sat down and cried when I opened it. Not because I think that we are actually going to have to pay it, but because it is another extreme hassle that we now have to deal with. I seriously don't have time for crap like this. Dealing with hospitals and insurance companies is extrememly stressful. One hand never seems to know what the other is doing. You get different people, with different levels of knowledge, who all tell you different things. At the hospital you always get, "well, I can set you up on a payment plan." No, you don't understand. I don't want a payment plan. I don't want to PAY. I don't owe. Someone made a mistake. PLEASE HELP ME!

Since I am talking about money and hospitals and insurance, I might as well give even more background information. In addition to this new bill, we have been dealing with close to $5,000.00 worth of bills from the NICU days, still unresolved. The insurance company rejected this amount, saying that we had to pay an "out-of-network" co-pay. It seems that two of the neonatologists who worked with H and E are "in-network" and two are "out-of -network." When the insurance company told me this, I thought it seemed ABSOLUTELY RIDICULOUS. They were in-patient, in intensive care, at an in-network hospital. We had no control over who the doctor on rounds would be on any given day. I talked with the doctors in question who agreed with me that the charges were ridiculous, and told me not to pay. They said that the doctors in the NICU are all in the same group and all accept the same insurance. Makes sense to me. Unfortunately, so far, NO ONE knows how to resolve this issue. The doctors say they are in-network, the insurance company says they are out-of network, and the hospital says "we want our money." Why has this become my problem???

To compound matters, consider this... We were told, and have since verified, that in the state of Michigan, all babies in the NICU for over 30 days automatically qualify for Medicaid, regardless of the parents income. While the babes were still in the hospital, I met with a hospital representative who completed the applications for me and sent them in. We were rejected because we were over the income limit. We called FIA, and were told the same thing...you make too much money. We called the hospital rep, who said "don't worry, I'll take care of it." So we didn't worry. We had many more important things to worry about. Like whether our babies were going to LIVE OR DIE. I guess we should have worried.

I don't know where to start. I don't know what to do. All I know is that we cannot afford to pay these bills. Even if we could, we shouldn't have to! Someone, somewhere made a mistake. The hospital rep who completed our Medicaid applications for one. Also the insurance company who denied our claim, and the hospital who cannot get it straightend out. Why is this my problem??? I've got babies to take care of people!!! And formula costs $100.00 a week!!!

On the brighter side, those sure are some cute, happy babies. And I LOVE them!!!:)

19 comments:

TBG said...

Good luck with that bill that stinks...

The girls are cute as ever!

patti roberts said...

Sorry to hear of the new hassels you are facing. Being insured is a necessary thing, but it becomes a pain in the neck sooner or later. I'll pray that the outcome is in your favor. It seems like you could get a representative (patient advocate) at the hospital and let them deal with it all while you take care of the most important part of this whole thing. . . .those precious girls.

Anonymous said...

OMG- $100 a week???

I had a bad billing experience too. I kept my last name after getting married and when my child was born, the nicu had her under my name. I kept telling them thats not her last name and they told me it was policy and not to worry.

My eyes popped out of my head when the first bill came for over $145,000. How I handled it (totally irresponsibly) was to let them sort it out when they didn't get the money. That worked for these big numbers, but not the smaller bills (that added up to over $12,000 in separate charges for imaging, etc.).

What has worked for me is dealing solely with insurance. The hospital people don't know what they are talking about and can't really help. They kind of confused things more because of the whole payment plan thing, like you said.

I just kept calling insurance every day until I found a very competent person who solved it all in one day. Now I have a couple of new bills, and will do the same thing. Hang up when someone is an idiot and keep trying until you hit the jackpot. They are out there and it only takes one person who gets it! -E

Kendra Lynn said...

Dear Billie and John:
I totally understand your frustration with the hospital and insurance situations...you are in our prayers.
We had a situation when Merry was born...SHE NEVER GOT A BIRTH CERTIFICATE! I delivered at St. Joe's, same as you, and they brought me a bunch of paperwork to fill out after Merry was born. I filled it all out, and never had another thought about it.
We got home and awhile later Scott was asking about Merry's birth certificate. It dawned on me that we NEVER GOT ONE!
We called and called St. Joe's...they gave us another number to call...the woman we were supposed to talk to never returned our calls. We finally packed merry up one day...months after she was born...and went to St. Joe's. We found the lady's office...she wasn't in, of course...even though we had checked out her hours beforehand. We waited around for quite awhile and she never came in.
So, after months of trying to get a birth certificate, we gave up.
Now we have to start our search again because she has to have a birth certificate before she can attend kindergarten.
Whew...anyway...I know how upsetting it is when you can't get ahold of the people that you need to talk to.
You are in my thoughts and prayers.
I love you.

Kendra

rumtum77 said...

I don't normally post much.... but I do read your blog and love seeing your little ladies...they are priceless. I wanted to let you know that you are in my prayers. Try to not let this overwhelm you (I know, easier said than done). Although I don't know you, I am keeping your family in my thoughts and prayers and sending you my best wishes. Good luck.

Amy said...

I have walked in your shoes. Actually, we still are. Our insurance company's policy is to not pay for the lab's interpretation of lab results, as the doctors are competent enough to interpret their own results. Brayden spent exactly 2 months in the NICU, having labs drawn several times a day EVERY day. The interpretation of those labs run between $7.00 and $23.00 PER TEST, which amounted to several thousand dollars of rejected claims. I am still fighting them.

We, too, were told by our hospital (Louisiana) that Medicaid covers any baby that spends over 30 days in the hospital. The rep at the hospital said that they may reject us the first time due to our income, but to reapply. Brayden (and definitely your girls, too) also qualified because of birth weight. Keep trying--we finally succeeded.

We also had problems with them rejecting claims due to duplicate claims because when the babies were still in the NICU, they were both under my name--even though one was BG1 and the other BB2. I finally got that straightened out, but I agree--WHO HAS TIME FOR THAT?

And, yes, we also spend $100.00 a week on formula because you can't just buy the frontline formulas for preemies--they have to get the expensive stuff.

I hope it works out without too many headaches. I'll be thinking of y'all.

Anonymous said...

B - if you need someone to come play with the girls while you spen hours on hold or someone to hang out at the hospital billing dept. with call me. It's impossible to entertain one kids for hours and just crazy to try it with 2 on your own. I'm good with borring situations and not too bad keeping twins entertained (and I can bring back ups)! Kim

Anonymous said...

Did I mention those are the cutest kids EVER?!?!

Mete said...

Oh, I know where you're coming from. So well. It's my life. Two or three days of the week find me calling someone to straighten out a bill or get something authorized.

I totally agree with the "one hand doesn't know what the other is doing" statement. On one day, I ended up calling our insurance company 4 different times - and got four different stories from the four different customer service reps. If THEY don't know what's going one, how should I??? When you add in the doctor's offices, the pharmacies, the labs... They all seem to be incompetent, and they make it your job to fix their mistakes.

The only tip I can give is to see if you can get a case worker at your insurance company. I have been told that this is usually offered to families with lots of bills. It helps to have one contact to handle your claims and answer your questions. Unfortunately my insurance company insists that they don't do that. Figures.

It's terrible that parents who have to deal with so many stresses from medical issues then have to deal with the stresses of money on top of it. Some days I wish I was rich enought to hire an assistant to handle the bills, paperwork and phone calls. It's a part-time job on it's own. So frustrating.

Sadye Spirit said...

Oh hun, I SO know what you are going through. We have the worst insurance ever (at least until March) and we still recieve bills from when the boys were in the NICU. Medicaid is a life saver, and your girls should have automatically qualified b/c of thier weight, and if you can get that worked out you can apply for back pay to when they were in the NICU.

I do not know if your state has WIC (Women, Infants, & Children) but if you qualify for Medicaid then you should automatically qualify for WIC. They have been a life saver for us, we save almost $600 a month on formula/Pediasure and cereal & juice.

Remember, you cannot go to debtor's prison. I have creditor's calling me every month because of insurance/hosptial conflicts. I think I am becoming numb to it...

Sending big hugs your way, those gorgeous girls are SO more important than worrying about the insurance vs hospital bureacracy...

Anonymous said...

Hi Billie,
I have to agree with some...find someone at the insurance company to become an advocate for you on this stuff! I know they exist for special circumstance cases!
My brother and sister in law had major charges written off from Carlos and Julianne's stay at U of Chicago when both were lifelighted from Michigan there because of the neonatal hemochromotosis.
Four years later the kids both had to have liver biopsies there and the doctor made all the charges "disappear" after they were billed $15,000...so it can be done.
Keep the faith..it will all work out sweetie. In the meantime...those are 2 BEAUTIFUL LITTLE GIRLS!
Love, Mamma Jules

Lauren said...

That is insane they are doing this to you. You don't have to qualify for SSI - it is automatic regardless of income if your babies are born less than 2 pounds 10 oz.

My problem now is trying to get off of Medicaid as we shouldn't qualify for it now that my babies are long out of NICU but we keep getting notices that the babies are enrolled (we never give the numbers out so it isn't used anyways)

How stupid of the hospital to make you go through this. I hope you can get this resolved without having to pay anything. The medicaid made a huge difference for even our out of pocket expenses.

Anonymous said...

I work with John. I would suggest a free service available to all Thomson employees (assuming this is through Thomson's insurance). It is called Participant Advocacy. They take care of disputes like this so you don't have to! I have a brochure on it and will copy it and give it to John.

-Steven Bee

liz.mccarthy said...

Hi Billie (Sorry I'm so behind on checking in on you and your girls, I have my own NICU issues right now), but I'm so sorry you are having to deal with bills from the NICU. Maybe there is an insurance advocacy program in MI...

When my twins were born, the insurance company denied all of Kaitlyn's bills, as they had her down as deceased (they confused Corinne with Kaitlyn). What a nightmare.

Anonymous said...

uuugggh. i cannot believe all of that crap. i'm soo sorry you have to even think about this stuff for a minute. hopefully the person that john's coworker mentioned will be able to help. again i say ughhhh.

you are right though - those are two beautful, happy babies and i love them too!
lis

Jim Fisher said...

Billie and John,

I doubt you remember me. You get many comments on your blog from many people. But I posted on your blog about 9 or 10 months ago. My wife and I had a triplet loss at 21 weeks in June of 2004. They lived for about 2 hours, then we said good bye. After about 6 months we tried again and got pregnant with twins. Which is how I stumbled across your blog (at the time my wife was 23 weeks with twins and I was looking up 23 week preemies in case she delivered early). When I read your story, I was blown away at how upbeat you were through your ordeal. You really inspired me to keep a positive attitude. Now I have beautiful twins born at 36 weeks (NOV 1 2005)and are now just over 3 months old, Joshua and Lillian. I correspond occasionally with your friend Kendra Lynn. I havent thought about you and your twins for some time since I have been so busy with mine. But the other day it hit me and I thought I should check up on you. I want to thank you guys for being a great inspiration to me. I hope your girls are healthy and I will pray for their well being. I am sorry you are dealing with this insurance hassle, but keep the attitude you had from the start of your babies life. Money means nothing. You won't have to pay it, so don't let it get you down. Keep in mind that hospital bills can not show up on your credit report even if they are negligent. The things we worry most about, are the things that affect us the least in our life. Its the thing that blindsides us at 3 a.m. on a Thursday morning that we never thought about or saw comming, that affect us the most.

Billie said...

Jim,
Congratulations on the birth of your twins! It's funny, just two days ago I was going through blog comments trying to find yours so I could catch up on your story and see how your babies were doing. Perfect timing! I am glad to hear that you had a happy ending...and beginning. Thanks for your words of inspiration.
Billie

The Ryan Family said...

Your blog is great and your girls are gorgeous. My twins (28 weekers) will be turning one this month, it's a great milestone and my eyes fill with tears everytime I think about it. Thanks for sharing your story!
Kristina

Gabi Moore said...

i just wanted to let you know of how much hope your baby girls brought me...i fist saw you blog last fall, just a few months after my baby girl was born. she was born at 25 weeks, 1pound 3oz. for several months we had no idea if she was going to survive or not. nobody know how that really feels till you have your own baby rushed in to the nicu (i had no idea either!). seeing how good you girls look and how similar to my baby they looked when they were born, made me think that life was possible for her, it was just a matter of time... she finally came home in deceber, five months after she was born. she had a feeding tube inserted in her belly, oxigen 24 hours a day, apnea monitor and about 10 meds that i had to make sure to give it to her right on time. today, she is a beautiful, happy little girl, almost over 12 pounds and about to turn 8 months next sunday. at the time, i wanted to share this with you, but my "spirit" was so broken that all i could do was cry for my baby's life...today things are almost like if nothing had happen, but we still keep her at home, just go out for doctor's visits and rsv shots. she also just started bottle feeding 2 weeks ago, and she is able to breathe without extra O2 most of the day. things look and feel bether now, but we are aware that things r discovered as she grows, and we will have to be ready for all the support she'll need in her future.
we'll keep you and your family in our prayers...just one more thing to share...look how special our babies are, and only we know how much they fought to survive (or how far we pushed them to stay around...). as my mom said to me a few days ago, we r not the same people we were before all this, and now look how many other moms and we can help, sharing our stories...
God bless you