How do you deal with Insurance refusing to pay because Hospital overcharged ?

[cyber888]

That's the way I do it. They will often send a bill with a subset and try to get some money out of you early. I completely ignore anything sent before I get a complete EOB. Meaning every supplier has made their claim. Then, if the supplier has any relationship with the insurance company (negotiated rates in the secret contract that we as consumers are not privy to), I call the billing office and tell them if they want to get a dime, they need to address whatever issues I have, like an out of network contractor or something. They can send it to collections, I don't care. Unless they convince me I'm not getting cheated, I don't pay the first dime.

Thank you. This is my train of thought. Very encouraging.

 

[cyber888]

Thanks. Yes, this was an ER visit. I see that ER visits are protected in NC based on that article. Nice find.

But for ER visits (only) you don't have to pay in NC.

They can still bill you, but:

"Limited to hold harmless provisions. In 12 states, balance-billing protections only require insurers to hold consumers harmless from the billed charges of providers but do not prohibit providers from sending bills. Because these states do not prohibit providers from balance billing, consumers may still receive a bill from a physician, hospital, or other provider."

https://www.commonwealthfund.org/pu...n/balance-billing-consumer-protections-states

 

[sengsational]

How do you know when that is? I fortunately have little experience here, but for some minor things, I seem to get some ancillary charges months later for something related to the date-of-service.

That's a law we need...you don't bill within 30 days, you dont have a claim! I don't for sure all bills are in, but 60 days is when I go through the pile the first time. It was hard for me to adopt this process, because I pay on time for everything else. But I feel I am at such a disadvantage with the provider and insurance company ganging up on me with their secret contract. If I have a problem, I make one call to the provider and one call to the insurance company, each time telling them my next action will be with the attorney general. Many times that saber rattling is all that's required.