Claims Submitted Out of Order and Now I Owe an Extra $4,000+

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We had our 4th baby in September and typically have successful home births (yes, we practice black magic ๐Ÿ˜€ ). The midwife’s clinic is out of network for our health insurance. It’s expensive enough that their claim would cover my in-network out of pocket max (I have deductible cross over). So even if something went wrong, the insurance would cover the in-network hospital 100% (confirmed with them).

Well, something did go wrong (everything ended up well in the end though), and my wife ended up delivering in the hospital. Here’s where it gets fun. Even though I had paid the birth center in full ahead of time, the hospital submitted their claims first. Now I owe the hospital over $4,000 in addition to the money I’ve already paid the midwife (which was $5,500 I believe).

I know I should theoretically get some level of refund when the birth center finally gets their claim submitted correctly, but since it’s out of network, the refund will be less than what I owe the hospital and I will go out of pocket more than I would have if they claims went in in the correct order.

So to recap, my out of network claim should have covered my in network out of pocket max, but instead, my in network claim came in first and that is what covered my in network limits. Now I still have some way to go with the out of network claim to hit the out of network deductible.

I feel like I’ve been totally screwed here. Is there any recourse at all?

submitted by /u/Destriers
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We had our 4th baby in September and typically have successful home births (yes, we practice black magic ๐Ÿ˜€ ). The midwife’s clinic is out of network for our health insurance. It’s expensive enough that their claim would cover my in-network out of pocket max (I have deductible cross over). So even if something went wrong, the insurance would cover the in-network hospital 100% (confirmed with them). Well, something did go wrong (everything ended up well in the end though), and my wife ended up delivering in the hospital. Here’s where it gets fun. Even though I had paid the birth center in full ahead of time, the hospital submitted their claims first. Now I owe the hospital over $4,000 in addition to the money I’ve already paid the midwife (which was $5,500 I believe). I know I should theoretically get some level of refund when the birth center finally gets their claim submitted correctly, but since it’s out of network, the refund will be less than what I owe the hospital and I will go out of pocket more than I would have if they claims went in in the correct order. So to recap, my out of network claim should have covered my in network out of pocket max, but instead, my in network claim came in first and that is what covered my in network limits. Now I still have some way to go with the out of network claim to hit the out of network deductible. I feel like I’ve been totally screwed here. Is there any recourse at all?
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