Medical / Insurance Billing Woes

[92saturnsl2]

Wondering if anyone has come across a situation like this before. I received a bill from a medical provider a couple months ago, for a visit that should have been paid out 100% by my insurance, in fact I checked ahead of time with my insurance company. In network, no deductibles, no co-pay, etc. I figured maybe they don't have my insurance on file even though I gave it to them at time of service. I sent them a letter by mail with my insurance information and figured that would be the end of it. Today I receive another bill threatening to send me to a collection agency. I call them and they say my insurance company denied the claim and that I need to call my insurance company. I call Humana, my insurance company and they confirmed the service should be covered but have never received a bill for the claimed date of service. They give me a provider telephone number to give to the billing people. I call the billing people back and attempt to have them call my insurance company at the number the insurance co. provided, and they state that they are an incoming call center and cannot contact my insurance company. I ask them to resend the bill to my insurance company, they claim they cannot do this because it would be "duplicate billing" and gave me the impression that it was not legal to rebill. Frustrated after spending an hour up to this point, I call my insurance company and they are just as dumbfounded as I am that a provider that wants money refuses to call the insurance company, the only means of them getting their money! The insurance company basically tells me that nothing will happen unless I can somehow get the provider to call them or send another bill. What are my options? I refuse to pay based on principle alone (along with the fact that it's a fair sum of money), how does one handle this, especially if this finds its way as a collection account on my credit? I tried getting the two companies' statements they made regarding inability to bill / ins. company not received bill, etc. in writing, but both parties essentially refused.

 

[Lolvoguy]

Why not forward the bill/letter you received, to your insurance company. Unless I'm missing something

 

[92saturnsl2]

Originally Posted by Lolvoguy

Why not forward the bill/letter you received, to your insurance company. Unless I'm missing something

I investigated that. Problem is the "bill" I have doesn't have any of the pertinent info like service date, medical billing codes, etc. that the insurance company needs to pay the claim. All I have is an account statement threatening collection action from a medical provider that refuses to re-bill me or my insurance company.

 

[walterjay]

Contact the office of your Insurance Commisioner.

 

[Gebo]

Ask the billing company to send you the itemized bill with all services and codes on it. Then you can forward that bill to your insurance company??? maybe???

 

[Hall]

Call the doctor's office that you had the procedure done at. Don't ask for the "billing" folks either who may be outsourced or at a central location for many different doctors, talk to someone at that office. Explain to them what's going on so they can have it (re-)processed correctly.

 

[92saturnsl2]

Originally Posted by Gebo

Ask the billing company to send you the itemized bill with all services and codes on it. Then you can forward that bill to your insurance company??? maybe???

They claim that they have already sent the bill and to send another would be "duplicate billing" and is prohibited / illegal or something to that effect. I'm stuck in this circle of one telling me to call the other. I'm not sure the insurance commissioner is the appropriate agency; my insurance company is cooperating and borderline helpful, it's the medical provider that is being a stick in the mud.

 

[skyactiv]

Are you far from the medical provider you used? They might have someone in the office that can deal with it and get it straightened out. Did you ask to talk to a supervisor while on the phone Are you sure the bill is legit? It wouldn't surprise me if hackers have duped people after hacking into databases and knowing a little to much. Was you notified by your insurance company why you were denied coverage?

 

[walterjay]

In Maryland the Insurance Comissioner holds some sway over medical providers. Call and ask if they can help.

 

[mk378]

If the only paper you received doesn't have service date, patient name, billing codes, etc on it, they didn't send you a bill either.

 

[spackard]

Frankly that's B.S. they can't send another itemized bill to the insurance company. If the insurance company indeed receives a duplicate bill they'll refuse to pay and code it as a duplicate. Big whoop. It's also acceptable for you to get an itemized bill, and for you to submit it to the insurance company. If you have enough spare money, you can pay the provider then get the insurance company to reimburse you. That said, on the back of one of my bills, it says: BILLING POLICY Payment is requested at the time this bill is rendered. In the case of health care insurance, this office will provide the patient the service of completing their health care forms and transmit them to the patient insurance carriers. Patients who carry health care insurance, however, should be reminded that professional services are rendered and charged to the patient and not to the insurance company. This office cannot accept the responsibility of collecting the patient's insurance claim or for negotiating a settlement on a disputed claim. The patient or the patient's responsible party is responsible for payment on their account within the limits of our credit policy. So, although the provider is trying to work with the patient, this bill obviously says it's ultimately up to me to pay.

 

[zzyzzx]

I would personally show up at the provider and call the insurance company from there. I think that the medical provider is trying to scam you, or incompetent.

 

[Gebo]

Originally Posted by 92saturnsl2

Originally Posted by Gebo

Ask the billing company to send you the itemized bill with all services and codes on it. Then you can forward that bill to your insurance company??? maybe???

They claim that they have already sent the bill and to send another would be "duplicate billing" and is prohibited / illegal or something to that effect. I'm stuck in this circle of one telling me to call the other. I'm not sure the insurance commissioner is the appropriate agency; my insurance company is cooperating and borderline helpful, it's the medical provider that is being a stick in the mud.

I was thinking that you personally get a copy of the itemized bill.

 

[JayhawkRoy]

Time to send your medical provider a concise letter pointing out that neither you nor your insurance company has received a bill with all the correct information that could be used to adjudicate the claim. You can follow up with telephone calls, but you need to document your efforts to resolve the issue.

 

[Dinoburner]

Something is amiss here and someone above the unhelpful one need to intervene.

 

[ecotourist]

Originally Posted by 92saturnsl2

They claim that they have already sent the bill and to send another would be "duplicate billing" and is prohibited / illegal or something to that effect. I'm stuck in this circle of one telling me to call the other. I'm not sure the insurance commissioner is the appropriate agency; my insurance company is cooperating and borderline helpful, it's the medical provider that is being a stick in the mud.

The way they can do this legitimately is to resubmit the bill marking it clearly "Duplicate Billing or Resubmitted Billing" (ie a duplicate copy of a bill that hasn't been paid). That way no one can say anyone is "double billing" (ie trying to get paid a second time for the same service). With lots of billings and lots of payments it's not that unusual that some bills don't get paid. I used to review the billings and payments received periodically and resubmit the ones that hadn't been paid (maybe a half dozen or a dozen bills in a 3 month period). In almost every case the resubmitted bill would be paid. I had to write off 2 or 3 bills a year as "uncollectable", usually because I wasn't on the ball about resubmitting the bill in time. There's usually a drop dead period (6 months after a visit or procedure maybe) after which a bill won't be paid. If they won't do this, you could ask for a detailed copy of the amounts owing and submit that to your insurance company with a letter of explanation.

 

[csandste]

In 2017 I went to my annual Medicare Advantage dog and pony show sponsored by Aetna. They announced that CVS was taking over Aetna and that we could go to any CVS minute clinic and pay the same co-pay as our primary-- ten bucks. I had a burn that wouldn't heal so I went in and talked to the NP. I said I want to be sure this is a $10 co pay. She double checked and said yes. She checked my blood pressure which was a bit elevated and gave me a script for a tube anti biotic, I had been taking the over the counter one but this was a different formula. I then remembered that my bp was probably elevated because I'd come from a meeting and downed about a quart of ice tea. I stuck my head inside her exam area and she said "oh, that explains it". A month later I got a bill from Maine for a diagnostic consultant in Kansas for $90. I portaled my insurance company and they said that I should have gotten my pcp's approval. I said that we were specifically told at the annual meeting that no approval was necessary to which they said, well they apparently made a mistake, do you have that in writing? They reversed the bill but said the "consultant" would probably re-bill. After several months of going back and forth and getting legal action will be taken notices, I gave up and paid the ninety bucks. It could just as easily been $900 or $9000 although I would have spent a lot more time fighting it. Medical billing is like playing "gotcha" chess. God know what you face if you have a stroke and wind up in the ER with a half functioning brain and the ability of the medical profession to screw you out of thousands.

 

[Alfred_B]

Ask the provider to give you the EOB. That will include the denial code from the insurance company. If they don't have an EOB, it's possible that they did not bill timely so are transferring the balance to self-pay.

 

[ffhdriver]

My state insurance department wrote one letter to my insurance company and they paid the bill and quit bothering me.