My husband's insurance refuses to pay the hospital bill - what should we do?

My husband's insurance refuses to pay the hospital bill - what should we do?
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#1

He retired in early May 2015 and has Blue Cross Blue shield until June 1st. He had a heart attack on May 13th. We called Blue Cross and they said he was covered. Now thy say Medicare is supposed to pay and Medicare says Blue cross is supposed to pay. The Bill is $121,000. At that time we did not have a supplement. The heart attack happened a week after he retired. They have gone back and forth a couple of times over this. What to do?


#2

He retired in early May 2015 and has Blue Cross Blue shield until June 1st. He had a heart attack on May 13th. We called Blue Cross and they said he was covered. Now thy say Medicare is supposed to pay and Medicare says Blue cross is supposed to pay. The Bill is $121,000. At that time we did not have a supplement. The heart attack happened a week after he retired. They have gone back and forth a couple of times over this. What to do?

So sorry that this is happening to you and your husband.  Its sounds like an clear case, (based on the information you have provided)  that Blue Cross is the primary insurance during the time of care.  There are few things to consider that may work to get this issue resolved.  First,  if your husband insurance is through his employer, contact the benefits administrator, or H.R. department to seek assistance with the coverage terms/dates.   They have some vested interested in helping you if the policy is employer sponsored.   Second,  contact the states insurance commission.  http://www.naic.org/state_web_map.htm   This link provides resources for most states.  The state you live in, may have a consumer complaint / assistances services or resources that will walk you through the process.

Lastly,  you may benefit from the services of a patient advocacy service. 

If you need assistance or have any questions, please feel free to contact me.

Good luck

Lisa Homan


#3

This is an unfortunate situation, especially at such stressful times, but which can be remedied.

If your husband retired sometime in May, Blue Shield is in its right to deny payment, or request a Medicare EOB first. Medicare is usually effective on the 1st of the month of the person's month of birth, in your case I assume May 1st. Blue Cross Blue Shield becomes secondary.

There are circumstances where Medicare might be secondary to Blue Shield, but these are limited.

Your best and first move is to call Medicare at 800-MEDICARE, and ask when or if Medicare coverage was effective on the date of service. If yes, give that information to all the providers, and your balance should be reapplied to "insurance responsibility" until both policies have paid.

If Medicare was not effective, and is not at this time, you can get a letter from Medicare to that effect, which Blue Shield should receive in order to update their system, and show they are the only coverage. This will get the claims paid.

Another option is for you to ask for Medicare coverage retroactively to May 1st (if your husband was or turned 65 that month), should this not be the case. Paying Medicare premiums retroactively will save you tons of $.

A note of caution: If you have Medicare Advantage, you may encounter difficulties having that insurance pay. Although emergency services are to be paid according to a couple of federal laws, this might take filing an appeal or extra paperwork to get it covered.

Best of luck to you,

#4

I would start with Medicare and verify the effective date of coverage to be sure that BCBS was primary.
I would then do an appeal to BCBS with a copy of the Medicare denial. Explaining the situation and your claims should be paid.
If you need assistance please reach out to a medical bill advocate.
Best of luck to you!
Cheryl Welch, MBA
Hudson Valley Medical Bill Advocate


#5

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