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Old 15.01.2016, 10:15
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Medical bill paid twice - help

Hi all,

Before Christmas my partner was taken to hospital after she had a accident at work. She received a bill from the hospital and because it was under her excess/franchise she paid the bill, the hospital have since sent her a receipt to say it has been paid.
However today she received a letter from the insurance company saying they paid the bill and has 30 days to pay them. She never contacted the insurance company regarding the trip to the hospital or the bill. We were confused regarding how the medical insurance works but now we are further confused.

Why would the insurance company and should we be looking to claim the money back or should the insurance money claim the money back themselves from the hospital.

Please help
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Old 15.01.2016, 10:21
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Re: Medical bill paid twice - help

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Hi all,

Before Christmas my partner was taken to hospital after she had a accident at work. She received a bill from the hospital and because it was under her excess/franchise she paid the bill, the hospital have since sent her a receipt to say it has been paid.
However today she received a letter from the insurance company saying they paid the bill and has 30 days to pay them. She never contacted the insurance company regarding the trip to the hospital or the bill. We were confused regarding how the medical insurance works but now we are further confused.

Why would the insurance company and should we be looking to claim the money back or should the insurance money claim the money back themselves from the hospital.

Please help
Accident at work = employer accident insurance (Suva) not employee healthcare insurance.
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Old 15.01.2016, 10:22
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Re: Medical bill paid twice - help

Normally the costs should be covered by the company's accident insurance ( assuming she works more than 8 hours per week) and has nothing to do with her health insurance. AFAIK the employers accident insurance is not subject to the franchise so she shouldn't actually have to pay anything.
She needs to contact the insurers and explain the situation. Did she fill out an accident form for the insurance? Normally they will send one to you as it's usually pretty obvious if it was an accident rather than illness.
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Old 15.01.2016, 10:25
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Re: Medical bill paid twice - help

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Accident at work = employer accident insurance (Suva) not employee healthcare insurance.
FTFY.

Tom
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Old 15.01.2016, 10:30
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Re: Medical bill paid twice - help

hi guys

Thanks for your help. Yes she works 100%
She has not been sent any paperwork from Assura to fill out just this letter with the bill.
She had a headache, and lost her balance and a colleague called An ambulance and she was taken to hospital, they ran tests and let her out a few hours later.
She thought this isn't a accident as such so she will pay the bill that came from the hospital.
The hospital replied with a receipt and a copy of all her test results.
Nearly 2 months later the insurance company say they have paid the bill and would like the money back.
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Old 15.01.2016, 10:35
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Re: Medical bill paid twice - help

In which case it was probably covered as a health problem rather than an accident. Talk to the insurers and explain that the bill has been paid. Although often a hospital bill comes in several parts, the intitial visit- and tests, etc, billed separately. Are you sure it is the same bill for the same thing- or an extra one?

Sorry this happened, but may I say, would it not be better to ask the Insurance direct?
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Old 15.01.2016, 10:38
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Re: Medical bill paid twice - help

Get in touch with your insurer.

Ideally they'll ask you to send the receipt to them (which is always a good idea anyway, even if you paid. It counts to reduce your outstanding excess (though in your case it's moot as it's a new year now)) and then they will claim the second payment back from the hospital. They are in a better position to get the hospital to refund the payment than you are.
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Old 15.01.2016, 10:39
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Re: Medical bill paid twice - help

We have written to the insurance company to ask the question but was more confused has to why they have paid when we never sent them a bill.
The bill from the hospital had a comprehensive break down for what was covered in the bill and for the cost of each thing which came to the total amount we paid.

Thanks all for your help, i guess I will await the insurance company response.
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Old 15.01.2016, 10:41
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Re: Medical bill paid twice - help

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more confused has to why they have paid when we never sent them a bill.
Hospitials will often directly bill your insurer. More unusual in this case is that they billed you too.
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Old 15.01.2016, 10:44
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Re: Medical bill paid twice - help

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She has not been sent any paperwork from Assura to fill out just this letter with the bill.
She won't be sent any paperwork, she has to go to HR and request an accident form.

Is it possible that the bill the insurance is claiming is for the ambulance? An ambulance is billed separately from the hospital bill.

Tom
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Old 15.01.2016, 10:45
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Re: Medical bill paid twice - help

Ok I will advise her of this. If there is a accident in future. However I don't think this is classed as a accident as such.
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Old 15.01.2016, 11:29
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Re: Medical bill paid twice - help

The definition of an accident is given here in the SUVA homepage. Sorry it is in German but I haven't time for translating this morning.

The most important bit:
For something to be classed as an accident, there has to be an 'outside factor' involved. In older people, a fall, even if the fall causes a broken hip, might well be attributed to 'dizziness=illness', a torn tendon to 'wear and tear caused by old age = illness' and is thus not considered an accident.
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Old 15.01.2016, 11:43
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Re: Medical bill paid twice - help

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Accident at work = employer accident insurance (Suva) not employee healthcare insurance.
Not necessarily SUVA, other companies also provide cover. You should ask your employer who they use.
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Old 15.01.2016, 11:49
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Re: Medical bill paid twice - help

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Not necessarily SUVA, other companies also provide cover. You should ask your employer who they use.
Indeed. OH's employer use Baloise for their accident insurance.
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Old 15.01.2016, 11:51
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Re: Medical bill paid twice - help

Probably other insurance companies use similar definitions for accident v. illness though.
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Old 15.01.2016, 12:00
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Re: Medical bill paid twice - help

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Probably other insurance companies use similar definitions for accident v. illness though.
I'm sure they do. I doubt very much if any insurer would class a headache as an accident even if it did result in a fall.
The OP was misleading initially stating it as an accident at work but he's cleared that up now.
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