[bmom and adoptm]

O.K. this is the deal. Last night G called me crying after talking on the phone with the adoptive mom. G delivered in March 2003 and released her infant for adoption. The state of CA who is 14 billion in debt most graciously paid for G's medical bills except that G received an anesthesiologist bill for $1300. The bill has gone unpaid and now G is in collection. It is possible that the anesthesiologist may have told the birthmother (while she was in labor) that she would be responsible for that bill. G doesn't really remember. If you think about it...these MD's have to pay huge malpractice premiums and it would make sense that they could
refuse to accept the reduced Medi-Cal payment for their services.
Anyway, the adoptparents have been aware of this situation for at least 7 months. Their response has been...we are not legally responsible for this bill. They are probably right...as far as "legally responsible," but what about morally responsible? What do you think?
Don't forget who has the stretch marks?

[tobeafamily]

I believe Federal law compels in-hospital physicians such as anesthesiologists, radiologists and pathologists to automatically participate with all plans, including Medicare, Medicaid and CHAMPUS/TRICARE. This is primarily BECAUSE the patient has no 'choice' as to which provider they use - it's whoever is covering service or is contracted by the hospital.

Bmom should contact the California State Medicaid/Medical Program Ombudsman, the State Insurance Commision and the hospital. If she was eligible for and covered by the state's medicaid program, than this should include anesthesiology, radiology and pathology service. They cannot 'balance bill' her either for charges beyond what Medicaid/Medical pays.

As to whom is responsible, morals vary by person. If the afamily didn't agree to pay medical expenses, than that's that. Legally, if this woman was a Medicaid/Medical beneficiary/enrollee, that program is responsible. In my days working for managed care, I saw MANY a physician attempt to collect fees beyond what they were entitled, knowing full well that they shouldn't, with the attitude that if they got the money, great. If they got caught, they'd stop IN THAT INSTANCE only but continue with others. Eventually, fraud & abuse comes after them, but only after many complaints and many people paying money they don't owe.

HTH,

Regina, AMom to Ryan Joshua Thomas

[BrandyHagz]

Is there an agency involved?

I know, at least when I placed in 1997, anesthesia was “elective” for a vaginal delivery and if I elected to have it during childbirth, Medicaid would NOT pay for it. I did, however, elect to have it…and the bill was sent to the agency, and was paid by the adoptive parents.

My daughters parents agreed to pay all medical bills associated with my pregnancy and delivery, and they made it clear (while present in the room during delivery) that they were perfectly fine with footing the bill in order for me to be comfortable.

In the end, the taxpayers footed most of medical expenses, I’m not sure how much the anesthesia was, but it was a fraction, of what, I’m sure, Medicaid paid for the birth of my daughter.

[bmom and adoptm]

thanks to both of you----
this was an attorney adoption.

[bromanchik]

Have you talked to the attorney?

[DeeAnn]

We are adoptive parents and we are just middle income and I think it was awful for the adoptive parents to say it is not their bill. It is their bill and they need to be reminded how badly they wanted this baby. Sometimes we forget the trials of adoption once our child gets to come home with us. We adoptive parents put out alot of money to bring a child into our life and it is just a part of the process. Sad to hear another adoptive parent fell short of their part. Shame on them!

[spaypets]

In addition to the advice given, G. should contact the hospital (not the bill collector) and see if she qualifies for their charity care program (since she qualified for Medicaid in the first place, I expect that should be able to get it). Hospitals are willing to work out payment plans with patients also.

I have to admit I'm pretty horrified that Medicaid won't cover anesthesia in a delivery. May the rule makers who thought of that brilliant condition have to pass a golf ball size kidney stone. Jeeze.

I don't agree that the aparents are responsible if that wasn't the arrangement upfront. It's possible that they have as much trouble coming up with $1,300 as G. does.

[Resseda]

It seems like somewhere along the line, something should have been mentioned, written or drawn up about unreimbursed (medical) expenses. Speaking only for myself, that was the first thing I brought up once I had selected my son's afamily.

Check into the other avenues, like the charity care and medicaid etc, but, and sorry if this is unpopular, if you had given birth to the child you now hold and love and care for, you'd be responsioble for the bill. Yes, $1300 can be a lot of money, but...to me, it's just one of the costs associated with the pregnancy/labor/delivery/birth/raising of a kid, even if the bill trickles in a year later and hasn't been budgeted for.

Ress

[maryjanek]

I have to admit I'm pretty horrified that Medicaid won't cover anesthesia in a delivery.

When I had my daughter in 1981 I got a bill from the anesthesiologist even though I opted not to use anesthesia. I was told he had to be present, and therefore he had to be paid.

[patrisha]

Tobeafamily was right. If the hospital bill was covered under Medicare/Medicaid, then so should be the anesthesiologist if he was required by your physician. I have gone round and round with providers on this point and not lost in the end yet.

In fact, if your doctor chose the anesthesiologist, then it was his responsibility to make sure he was in the elgible network. They cannot come to you in the 11th hour and tell you will be charged! Any agreement you made would be classified as "under duress" and not binding anyway.

Write a letter to the collection agency giving them your coverage information and tell them the charges must be submitted to the plan that covered you. Be aggressive and demand that they remove this bill from collections immediately. Send that letter registered mail, and copy it to the California State Medicaid/Medical Program Ombudsman, the State Insurance Commision and the hospital (thanks tobeafamily that I could copy and paste!).

I have found anesthesiologist's to be the worst about not wanting to belong to the plans, then trying to bill the patient for everything from overages to the entire bill.

Good luck

Trish

ps - I got billed for circumcising for my daughter! (I told them that they must have gotten carried away! LOL)

[DianeS]

Anesthesiologists are known for not submitting their bills correctly (to insurance plans of any kind). I don't think I've ever had one submit the bill to the proper place at the proper time, and willingly accept what they'd agreed to accept when they went on that plan. Don't be bullied - you probably know someone somewhere who has dealt with something similar and won. Talk to your friends and see if anyone has tips.

Also, pull out your copies of anything you signed while in the hospital. It doesn't matter what you "remember", what matters is what you signed. If you signed something saying you'd be responsible for anything Medicaid didn't cover, then you should be shown what you signed. If you signed, you probably don't have much hope of avoiding paying. If you didn't sign any such thing, then they're billing you for something you didn't agree to pay for, so hold your ground and don't pay - take patricia's advice about the letter and why you shouldn't owe.

By the same token, either the adoptive parents signed something saying they'd be responsible for medical costs - or they didn't. If they signed, they're liable and you should be able to go after them for the money. If they didn't sign, then they didn't agree, and aren't responsible for the money. Pushing for the money could ruin their relationship with you. Some adoptive parents are very clear about not being willing to pay medical or living expenses, and they choose their match based on that.

Changing the rules of the agreement on them and saying they should pay for something they didn't agree to isn't any different than what the anesthesiologist is doing by changing the rules of the agreement with you and saying you should pay for something you didn't agree to.

[bmom and adoptm]

DeeAnn, Resseda--great stuff.
many thanks to all of you.
it is good to be able to pass on the info. re: anesthesiologist
unconventional billing methods.
it would be more protective of the birthmom if these bill responsibility questions could be handled through the attorney rather than hashed out between themselves...that would help me to calm down as i feel protective of the birthmother. that 1st year after relinquishment can be a pretty fragile one.