Is there such a thing as an anti-refund?

January 24, 2006 10:42 AM

What do my parents owe the hospital?

Bill Filter
My mother went in to the hospital, here in Austin, Texas, last spring. Shortly after getting out she got a bill for ~$2700, which she promptly paid.

A few months later, the hospital sent her a check for $1250. When she called to find out why, a hospital billing person said that the hospital had miscalculated the amount she would owe after insurance, and that the check was a refund. She deposited the check, and has since spent that money.

Fast-forward to December. My mom gets a bill from the hospital for $1250 (the exact amount of the "refund"), with a notice that it wa past due. When asked, a billing person at the hospital said that she had only paid part of her bill. My mom eventually convinced them to check the records more carefully, and they found the record of the original check (for the full amount) and the refund. The billing person coulnd't explain why the error occurred, but insists that my mom owes the money, and will have to take it up with her insurance company.

I'm looking for educated opinions on whether or not my mom really owes this money (legal and ethical opinions welcome), and, better yet, pointers to resources to get some sort of authoritative answer.

posted by notbuddha to law & government (6 comments total)

If the refund was a miscalculation, she owes the money. If it was not, and a reason for the refund can be better found, then maybe she doesn't. Either way, is it cheaper to get a lawyer or to pay it?
posted by Kickstart70 at 10:52 AM on January 24, 2006

Well, without knowing more about the situation it's hard to say what she owes or is owed.

Does she have the original bill for $2700? Is it itemized? If it's not, she should insist that the hospital itemize it.

What does the bill for $1250 say? Is it itemized? If not, it should be.

Once she has itemized bills she should be able to compare them and figure out if they're double billing her for anything.

Is the billing person she's dealing with a debt collector? If so, she should insist that the debt collection agency refer the debt back to the hospital.
posted by bshort at 10:52 AM on January 24, 2006

Although she likely owes the money, there's a distinction between owing it and having to pay it. Hospital bills are regularly negotiated and altered. At the very least she should be able to get them to agree to a payment plan, which I would would even if you/she can write the check outright; they've inconvenienced mom already, no reason to let them really jerk around her budgeting.

As bshort mentions, you do want to make sure you're dealing the the hospital themselves. If this is a collector or worse yet, a debt buyer, the response should be much more hardassed. If for no other reason it will strengthen her bargaining position. A dead giveaway is if they gave her the mini-miranda ("this is an effort to collect a debt, all information gathered blah blah") before they spoke to her.

ArtOfCredit has a lot of information on dealing with debt collectors.
posted by phearlez at 11:48 AM on January 24, 2006

She should insist that the hospital provide full details of the originall bill, the refund, and very detailed reasons why they think she owes $ now. She should do this in writing, so she can keep copies. Good luck. Medical billing nighmares are a great motivator for staying healthy.
posted by theora55 at 2:04 PM on January 24, 2006

She also needs to contact her insurance company ASAP and get an explanation of benefits that covers her hospital stay. The EOB(s) will show what insurance paid, what she owed, and what the hospital wrote off under its contract with the insurance company.
posted by Carol Anne at 5:29 AM on January 25, 2006

Did the hospital assume insurance was going to cover the $1250 (causing them to give your mom the refund), only to have the claim rejected later? If the insurance company rejects the claim, then they would come to you for the money. You should try to follow up with the insurance company to see if a claim was made and why it might not have been paid, or not paid in the amount the hospital expected. It is possible that the hospital did not submit the paperwork to the insurance company correctly. It is probably also worthwhile to continue to follow up with the hospital and ask for copies of everything that was sent to the insurance company. It will take some patience to find the right person to talk to on both sides, probably, since they can both try to blame each other.
posted by babar at 9:23 AM on January 25, 2006