So when I was 38 weeks pregnant, the ultrasound showed that my daughter had aortic valve stenosis. The cardiologist confirmed it as well. He suggested that we deliver at the hospital where his clinic is at. However, this hospital is out of network in our insurance. My OBGYN said I just need to call the hospital because usually in these cases the hospital would match our preferred hospital. I called the hospital a week before my appointment and they said they can match it. He registered all my information. He said someone will called me but no one did. So we proceed anyway. After my daughter was born, the cardiologist did an echo and it was miracle that my baby didn’t have aortic valve stenosis or any heart defects.
When we got the bill for my newborn and I, it was a total of $8000. I thought it was A LOT since or my previous labors at our preferred hospital, the bill was around $700. I called the hospital to clarify if they matched before I pay. They said that there was no note of what I mentioned but they will figure it out. I contacted our insurance and they said we should’ve talked to them before going. Since we didn’t, we have to pay “penalty fees” and there’s nothing they can do except I will have to see what the hospital say.
At this point it’s been 3 months and I haven’t paid due to not knowing if they fixed anything. Then, I got a letter stating that it’s going to collection. I called the hospital again and they said it was declined. They never called or anything that it was declined. I was upset because we would’ve never gone to that hospital if we knew they weren’t going to match it when they said they would before we went. So they said they will report it again besides that all I can do is file for financial assistance.
Which I just received a “Notice of Determination” stating that we are approved but we have 30 days to appeal and explain our situation. Do I need to explain any of the above in the letter? What do I need to mention in the letter?
submitted by /u/FlyIcecream
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So when I was 38 weeks pregnant, the ultrasound showed that my daughter had aortic valve stenosis. The cardiologist confirmed it as well. He suggested that we deliver at the hospital where his clinic is at. However, this hospital is out of network in our insurance. My OBGYN said I just need to call the hospital because usually in these cases the hospital would match our preferred hospital. I called the hospital a week before my appointment and they said they can match it. He registered all my information. He said someone will called me but no one did. So we proceed anyway. After my daughter was born, the cardiologist did an echo and it was miracle that my baby didn’t have aortic valve stenosis or any heart defects. When we got the bill for my newborn and I, it was a total of $8000. I thought it was A LOT since or my previous labors at our preferred hospital, the bill was around $700. I called the hospital to clarify if they matched before I pay. They said that there was no note of what I mentioned but they will figure it out. I contacted our insurance and they said we should’ve talked to them before going. Since we didn’t, we have to pay “penalty fees” and there’s nothing they can do except I will have to see what the hospital say. At this point it’s been 3 months and I haven’t paid due to not knowing if they fixed anything. Then, I got a letter stating that it’s going to collection. I called the hospital again and they said it was declined. They never called or anything that it was declined. I was upset because we would’ve never gone to that hospital if we knew they weren’t going to match it when they said they would before we went. So they said they will report it again besides that all I can do is file for financial assistance. Which I just received a “Notice of Determination” stating that we are approved but we have 30 days to appeal and explain our situation. Do I need to explain any of the above in the letter? What do I need to mention in the letter?
submitted by /u/FlyIcecream [link] [comments]Read Morer/HealthInsurance