No. of Recommendations: 3

Since I don't know the specifics of your situation I will provide my perspective about how to approach the situation and how to avoid this in the future. FYI, before going back to grad school I worked for a hospital and had a lot of experience working with both hospital collectors and insurance companies.

The first thing you should do is get out all of the information (EOBs and bills) that you have received from your insurance company, the hospital and any doctors and review them. I agree that in 80% of the cases I have seen the problem is with an unpaid claim that either was never submitted to the insurance company or was not a "covered service" or had administrative problems (i.e. no referral number or a keying error) or was denied for some reason or the patient had a deductible/co-pay that needs to be paid. Many of these problems can be found by reviewing the paperwork.

If you can't find the problem after a review of the information you received I would suggest calling the hospital's billing area and asking about the bill and then call your insurance company. Many times you can find out why you received the bill and the steps you need to take. Don't be surprised if the reason that the hospital tells you the bill was unpaid by insurance is different than the insurance EOB or the insurance customer reps. It was often my experience that any single hospital claim could have multiple problems and only one is relayed at any point in time.

In the future (to avoid this type of problem-ignore if this does not apply)
-Make sure to open and review all communications from your insurance company and hospital/doctor. For example, I received an EOB where my doctor's visit was denied as not covered. After calling the doctor's billing area I found out they sent the claim to the wrong processing area. I was able to have them re-bill and have the claim paid.
-If you receive a bill that you don't think is your responsibility CALL THE HOSPTIAL/DOCTOR right away. If there is an error or if an appeal needs to be filed most healthcare providers will generally not send your account to collections if you keep them up to date on what is going on.
-Realize that mistakes can be made by both your insurance company and the healthcare provider. A simple keying error (on either side) can cause a mess. The hospital group I worked for had 45 billers who billed out about 650,000 bills a year (not including rebills). I'm sure the insurance processers face similar workloads.

Hopefully these steps will get you started. If you can provide more information I may be able to give you more specific help.

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