Problem Solver: Hospital billing causes financial sting

Crete resident who paid ER doctor's bill waiting for $345 refund after insurance covers entire amount

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When the symptoms first hit, Lynn Mattingly feared the worst.

With double vision and nausea, the Crete resident worried he was having a stroke.

His wife drove him to the emergency room at Franciscan St. Margaret Health in Dyer, Ind., where he was put through a battery of tests, including a CT scan.

The doctors could find no cause for the July 5 episode, and Mattingly went home.

In the weeks afterward, the hospital submitted the charges to Mattingly's health insurance company, which promptly denied the claim, saying the hospital did not provide the required information.

He spent several months talking to the insurance company and the hospital trying to get things ironed out.

In the meantime, he began getting bills for roughly $2,400 in emergency room charges. Repeatedly, he received extensions from St. Margaret while he worked to get the insurance mix-up resolved, and repeatedly there was miscommunication between the hospital and the insurance company, he said.

In a last-ditch effort to settle the matter, but still believing he would have to pay $2,400 in charges, Mattingly filed an appeal with his health insurance company near the end of 2012.

"I was told I would get an answer in a few weeks," he said. "I truly believed I was going to be denied."

On Jan. 8, he received a bill from the emergency room doctor for $345. Figuring the insurance was a lost cause, he paid the bill that day using a credit card.

A week later, he received a letter from his insurance company. It had reviewed his case — and decided to pay the charges, including the $345 doctor's bill.

Mattingly called the doctor's billing service and was told he would receive a check for the $345 within a month, he said.

It never came.

He called again in early April and was told the insurance company would send the money to the hospital, the hospital would send the money to the doctor's office, which would then send the money to him.

"They said there was nothing they could do until Franciscan St. Margaret issued the refund," Mattingly said. "I asked if there was someone at St. Margaret Health that I could call to help get the process moving and was told they did not have any idea who that would be."

Tired of waiting, he emailed What's Your Problem?

"All I want is my $345 back, and no one seems to be able to tell me how to get it," he said. "The billing service agreed it was due to me but seems powerless to get it to me."

Mattingly said he has called the hospital and the billing office but can't make headway.

"Everyone I talk to tells me they know nothing about it and that I need to call someone else," he said. "When I call the someone else, I get the same story."

The Problem Solver contacted Maria Ramos, a spokeswoman for Franciscan Alliance, which includes Franciscan St. Margaret Health.

On Wednesday morning, Ramose emailed to say that the bill was from the physicians, not the hospital, but she still investigated the matter. She said the check was issued April 16 and gave a name and phone number for the director of patient services, who Mattingly could call if he hadn't yet received the money.

Mattingly said he called the director Wednesday and was told that if the check does not arrive by the end of the week, the billing office would stop payment and reissue a new check.

"It's being mailed from Ohio. Why Ohio is involved in this, I don't know," Mattingly said. "We'll see what happens."

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