Insurance Asking for Pre-existing Information from Hospital

[Dangermoose007]

In Feb 2011 I went to the hospital for what turned our to be gastric ulcers. Having had a gap of coverage of 6 months and 1 day (1 day past cut off) and only being with my insurance for 5 months, they understandably sent out preexisting questionnaire to the doctors that treated me, and doctors I had seen out of pocket at walk in clinics while uninsured. All of my doctors from that visit have sent in the preexisting information that the insurance requested, the issue is, they also sent a preexisting questionnaire to the emergency room of the hospital itself. All of the doctors that treated me in the hospital sent theirs back, but the insurance wont pay the hospital until the ER sends back that info. When I speak to the hospital, no one there has ever heard of an insurance company asking for preexisting from a hospital itself instead of a doctor, and are refusing to send back the paper work for it.

Down the road 6 months I end up back in the hospital with the same cause (ulcers), but choose a different hospital knowing I was still having issues with bills in the first. Once again, my insurance sends out a round of preexisting questionnaires, which again, all of the doctors that treated me filled out, but there's a questionnaire for the hospital itself that, like the other hospital, this hospital wont fill out. Hospital number 2 says pretty much the same thing as hospital number 1; "We don't do preexisting forms, that's just for the doctors that treat you:"

Hospital 2 says they called my insurance and the insurance told them it was sent out in error, and they shouldn't be asking a hospital for preexisting info, yet they don't remove the requirement of the hospital to send it back, to pay them out. In addition, every time the hospital calls to inquire, they are told that the only thing remaining is for me to send back MY pre-exiting questionnaire, so the hospital thinks I'm not doing my paperwork, so I am getting bills threatening to go to collections.

HELP! Is the insurance allowed to ask a hospital for preexisting info? If so, is the hospital allowed to refuse to fill it out and send me to collections instead? Is my insurance allowed to tell the hospital they're waiting for preexisting forms from me, while they tell me they are waiting for preexisting forms from the hospital, I.E. trying to pit us against each other?

FYI this truly was not a preexisting condition

 

[STIBROKER]

they can do anything they want........they can pull records from doctors....hospitals....witch doctors.....

 

[leevena]

On a different topic, you may want to speak to the billing department at the hospital about this. They should be more than willing to work with you as the payment issue gets straightened out.

 

[Dangermoose007]

Thanks for the quick replies.
Leevena, I have spoken to both hospitals about the forms, but they both come back with pretty much the same thing, its no ones department to get these forms filled out, and they've never heard of it before. In regards to billing and collections, the oldest bill is fine now as we wait for this to be worked out, and the billing supervisor has been very pleasant to work with in regards to delaying collections. Its the second hospital I'm having issues with, they have awful customer service and aren't really working with me at all.

STIBROKER, they are allowed to pull records from anywhere they want, and I have no problem with them doing so, but there have to be some limitations on what they can request and who they can request it from. Surely they can't send a preexisting questionnaire to my boss or co-workers asking them if I've ever mentioned my ulcers before a certain date. They can't require my dentist, or hair dresser to send back info on how long he's been treating me, and they certainly can't withhold payment based on a non response from one of the above parties.
That would be like a judge asking a landlord what his tenants (doctors) and guests (me) talked about in the apartment he rented. A hospital can't diagnose me with anything, they only provide the rooms for the doctors to do it.

I guess right now my biggest issue is that to the hospitals it seems like I'm lying because the insurance agency is telling them I haven't returned my preexisting questionnaire, and that's the only hinge, but when I call, they say the only hinge is getting it back from the hospitals. So in the end,,the hospitals are less likely to work with me to get this thing hammered out if they think I'm responsible for the delay.

Note to self: Never get sick again.

 

[mmaedelins]

I would walk into the billing department of hospital 2. It's much harder to blow someone off when they are standing right in front of you. And I would also ask each hospital to send a letter to the insurance company stating that they do not fill out these preexisting forms. Then, call the insurance company to make sure they received the letters and ask them what the next step is since you obviously want to get this issue resolved. Don't give up and don't let them pit the two of you against each other.

Good luck!

 

[tins]

I guess right now my biggest issue is that to the hospitals it seems like I'm lying because the insurance agency is telling them I haven't returned my preexisting questionnaire, and that's the only hinge, but when I call, they say the only hinge is getting it back from the hospitals. So in the end,,the hospitals are less likely to work with me to get this thing hammered out if they think I'm responsible for the delay.

Note to self: Never get sick again.

Do a 3-way call with the insurance company and the hospital.
Then, everybody will be on the same page.

 

[Dangermoose007]

I decided to send it all in writing to my insurance company since I figured if the response is in writing, then they have to be very accurate with the information they provide. I got my response today, and the pre-existing from the hospitals is no longer an issue, woohoo!

But now they tell me they just sent out more pre-existing condition questionnaires to two doctors at a walk in clinic I visited in January 2012 8-\

How much longer can they keep sending out new pre-existing to people I'm visiting for the first time? Seems like if i ever want to get these bills paid I need to stop going to the doctor until the issue is resolved or they will just continue to delay payment by sending out more questionnaires

 

[Jack_Merton]

I've actually had an insurance company request the contact information for every doctor I've seen within the last 25 years while fishing for pre-existing conditions. It seems like there should be some regulation for this sort of thing.