Please Help – EOB and Bills don’t match and they’re threatening collections – IN, USA

TLDR; Indiana hospital is billing me for four accounts from hospital stay in May 2021, one of which ($43k) EOB said patient responsibility is “0.” The other 3 have “aging” days of 0-30 as of 12/5/22, yet they’re verbally threatening to send them to collections on 12/23/22.

This is really long. I’ve tried to include any pertinent details.

Long-Winded Details:

I was hospitalized in-network in the state of Indiana May 17- May 23, 2021. Majority of my stay was pre-approved as I started in the ER and moved to ICU (there was a letter on May 18 that approved my ICU stay). My insurance at the time was CareSource.

Bills started coming in and EOBs from insurance company originally had me paying maximum out of pocket. That all made sense to me but I’m applied for financial hardship aid because at the time I was making $27k/yr pandemic wages (restaurant). So the bills get put on hold during that process.

Over the next few months and into spring of 2022, this got put on the backburner by the hospital. When they got back to me they said they needed additional info (income statements from 2022, and some other clarifying documents regarding ones I had previously submitted). Late summer 22 they told me that financial aid had been denied because of my income (I’ve been working two jobs all of 2022). I say “Okay, I’m making more money now. Sucks that it wasn’t evaluated in 2021, but moving on.”

On September 4, 2022, I got an EOB from Caresource saying that due to “Adjustments based on CTV DRG Audit,” my patient responsibility for one account dated May 18 – May 23 is “0,” that Caresource paid “0,” and that the entire amount of $43,036.40 is marked as “Discount savings.”

Meanwhile, the hospital is billing me for 4 accounts total. 3 of which they say insurance paid in part (Smaller ones totaling $700ish patient responsibility). The last one was for the $43,036.40.

I called them and told them that the amounts don’t match on the EOB and the bill. They said they don’t have an EOB of 9-4-22 and that if a payment plan isn’t arranged, the amount is going to collections.

As I can’t send the EOB, the hospital said the insurance company has to. Called Caresource, and they said that the EOB is correct and that the hospital shouldn’t be billing me for the $43k. I said the hospital doesn’t have the latest EOB. I was able to get both parties involved in a 3-way call and Caresource said they mailed it, the hospital says they never got it. Neither budges on how to make it happen as the insurance company said they can’t send it due to HIPPA, and that the hospital “doesn’t know how to request something that they don’t have record of existing.” Insurance told hospital to go to the provider services portal.

The hospital resubmitted to CareSource for review instead. The insurance company denied re-reviewing and told the hospital to contact Provider services. Weeks later, after saying I may be getting the Dept of Insurance involved, the hospital said they “started trying to talk to provider services” (this at least is buying me time before they threaten collections for the $43k again).

The past couple months has been back and forth. Now, I get a bill from the hospital on 12/5/22, saying that the 3 accounts $700ish are now aged 0-30 (weird, they must have changed or something), the $43k account is pending insurance of $13,606, and they want me to pay the 3 accounts $700 by 1/4/23 or arrange for payment.

However, on 12/14/22, I get a call from the Hospital Billing Office. I called them back and they say that I need to pay those 3 accounts by 12/23/22 or they’re going to collections.

I said I want time to confirm with my insurance company that these are correct, that 12/23/22 is a date that I haven’t seen anywhere, especially for accounts that are now aged 0-30 days again (once again, suggesting some activity of some sort that I would like to look into). They said 12/23/22 is the date. I said how do we change that. They (billing office) said they sent an appeal and it was denied by the hospital. Can they just pull a due date out of their ass like that?

I also don’t trust what they’re trying to do with the random $13,606 on $43k bill… Even at max out of pocket I should be looking at $8.5k (in-network, I double-checked. And my diagnoses is covered). And because I don’t trust that, I don’t feel confident in paying the smaller bills with a random due date. Couldn’t one possibly affect the other? And they are trying to rush me into setting up a payment plan.

I’ve spent countless hours on this and am trying not to get stay frustrated. I usually feel like screaming into a pillow after every phone call. But everyone I talk to is saying that their hands are tied. Please help. I don’t understand how this sort of thing isn’t like super easy to fix for them. Do I need to lawyer up? Contact the Dept of Insurance?

Edit: Clarification edit Age: 30, 47904