Can insurance be rebilled at the patients’ request

Hi there,

Setting up the context, I live in FL 33511, my income puts me toward the upper limit of what is now covered by the ACA APTC, family of 3 up until Oct 18th when my wife gave birth. Of the 3 I am on a FL BlueSelect Bronze plan, 1737S, my wife is on FL BlueOptions Silver 1808, and my daughter has a Florida HealthyKids (Aetna) plan. Our (adults) plans were purchased directly through FL Blue, not via the marketplace.

On Oct 18th we went into the hospital to have a planned caesarian section. Our youngest daughter was born same day, and mother/baby ended up being discharged on the 21st.

We were fully prepared for the deductible/out of pocket maximum and had the pricing somewhat reaffirmed by several calls to her insurance. That being said, we ended up seeing on her plan’s claims online that the fees associated with our daughter were denied, and after calling the insurance company and explaining it was a newborn, expecting them to cover her for 30 days, they refused and said we can add her but it won’t be retroactive. (At this point we had also had to return to another hospital the day after being discharged because the pediatrician sent us home prematurely, so we knew between the existing visit and the pediatric ER we need retroactive coverage)

We could see the bills of what had been accepted and the patient responsibility was about $5500 ($3300 ded. met, on the way to $8,150 OOP), and the denied charges for our daughter were to the tune of $30k.

We began investigating our options and I decided to check what marketplace coverage looked like and I ended up signing us up for a BlueSelect Platinum 1457 plan that said its effective date would be 10/18, with $0 deductible, $2000/$4000 out-of-pocket in network, and had the hospital in-network.

When my wife called the hospital to speak to them about the insurance fiasco they stated that they can add the new plan as secondary insurance, but because it wasn’t stated before there were primary/secondary insurance plans they will likely deny the claims as secondary on the new plan.

My question is, can I request/expect/demand that they undo the billing to the first plan/primary (wife’s BlueOptions Silver) that has already been paid/adjusted and redo both my wife’s and my daughter’s bill under the new BlueSelect Platinum AND, is there anything further I should consider before attempting to go down this route? I 100% expect that the denied claims for my daughter should be satisfied to some degree by the new insurance (please let me know if this is an issue?), but I don’t know if the hospital will undo the billing to the first plan and put it through again to the new plan, as primary insurance. Any additional information someone feels may be pertinent to handling the situation is also welcome!

Thanks very much for taking the time to read through!

submitted by /u/Hex547
[link] [comments]Hi there, Setting up the context, I live in FL 33511, my income puts me toward the upper limit of what is now covered by the ACA APTC, family of 3 up until Oct 18th when my wife gave birth. Of the 3 I am on a FL BlueSelect Bronze plan, 1737S, my wife is on FL BlueOptions Silver 1808, and my daughter has a Florida HealthyKids (Aetna) plan. Our (adults) plans were purchased directly through FL Blue, not via the marketplace. On Oct 18th we went into the hospital to have a planned caesarian section. Our youngest daughter was born same day, and mother/baby ended up being discharged on the 21st. We were fully prepared for the deductible/out of pocket maximum and had the pricing somewhat reaffirmed by several calls to her insurance. That being said, we ended up seeing on her plan’s claims online that the fees associated with our daughter were denied, and after calling the insurance company and explaining it was a newborn, expecting them to cover her for 30 days, they refused and said we can add her but it won’t be retroactive. (At this point we had also had to return to another hospital the day after being discharged because the pediatrician sent us home prematurely, so we knew between the existing visit and the pediatric ER we need retroactive coverage) We could see the bills of what had been accepted and the patient responsibility was about $5500 ($3300 ded. met, on the way to $8,150 OOP), and the denied charges for our daughter were to the tune of $30k. We began investigating our options and I decided to check what marketplace coverage looked like and I ended up signing us up for a BlueSelect Platinum 1457 plan that said its effective date would be 10/18, with $0 deductible, $2000/$4000 out-of-pocket in network, and had the hospital in-network. When my wife called the hospital to speak to them about the insurance fiasco they stated that they can add the new plan as secondary insurance, but because it wasn’t stated before there were primary/secondary insurance plans they will likely deny the claims as secondary on the new plan. My question is, can I request/expect/demand that they undo the billing to the first plan/primary (wife’s BlueOptions Silver) that has already been paid/adjusted and redo both my wife’s and my daughter’s bill under the new BlueSelect Platinum AND, is there anything further I should consider before attempting to go down this route? I 100% expect that the denied claims for my daughter should be satisfied to some degree by the new insurance (please let me know if this is an issue?), but I don’t know if the hospital will undo the billing to the first plan and put it through again to the new plan, as primary insurance. Any additional information someone feels may be pertinent to handling the situation is also welcome! Thanks very much for taking the time to read through! submitted by /u/Hex547 [link] [comments]Read Morer/HealthInsurance

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