Billing Problem

[HF63]

Here in the mid west, we have health provider that is buying a lot of the small clinics. They seem to be growing like a weed. Earlier this year, I had a phone conversation with my doctor and some how the phone visit was miss coded and the claim was deny. I got the bill and try to contact the billing company but is a third party and said no help w/changing the code. I did spoke w/ my doctor clinic and it seems there is no way to make changes to rectify the problem. The provider has all the control from coding, billing, but unable to make changes for their own mistakes what a crap load. Will you pay for this bill??


Background info:


1. My deductible is X
2. When paying w/ credit card the charge is 4x (no medical insurance)

3. Claim is deny bill is 10x

 

[Sarah S]

It is probably true they can’t recode. I couldn’t when working the one time it came up though it was different. The person asked for and got a service their insurance ( unexpectedly to them and to me) did not cover.

As a patient I had a service that was denied because the associated diagnosis was not a covered condition. They had put down the wrong diagnosis. What I actually had was fully covered. They recoded it and it was denied again because the visit had already been submitted. Although I think it might have gone through if they did it another way I just gave up. The amount was very small though

If the doctor is working for a large entity they may not let them write it off. Really. But it still isn’t fair that you pay for something when you shouldn’t. Since it would have gone under your deductible have you used your deductible elsewhere? Are you likely to? If not I would be tempted to say I will pay what I would have paid (x) and no more

 

[pb4uski]

^^^ I don't agree. Our doctor's office would routinely miscode blood work associated with our annual physicals, we would get a bill for the blood test from the hospital that did the blood work since our insurer denied the claim based on the doctor's office miscoding.

Each year, I had to call the doctor's office twice a year... once for me and once for DW... and have them resubmit with the proper code and then the insurer would honor the claim. The doctor's office office manager and I were on a first name basis we talked so frequently.

Needless to say, they are no longer our doctor's office.

Double check with the insurer to be sure that if the service was correctly coded that it would be covered. Assuming yes, then refuse to pay the bill and ask the doctor's office to resubmit the claim to the insurer with the proper coding and the insurer will pay it. If they try to put it to collections, then say that it is an illegitimate bill and explain why.

Good luck. DW spent close to a year to resolve a similar issue. Sometimes I think they do it on purpose because many people will give up and just pay the bill to be done with it.

 

[braumeister]

I agree with pb4uski. I can think of at least half a dozen instances where my doctor's office submitted a claim that was denied. They simply submitted it again with a different (correct) coding and it was paid. Happens all the time.

 

[HF63]

Double check with the insurer to be sure that if the service was correctly coded that it would be covered. Assuming yes, then refuse to pay the bill and ask the doctor's office to resubmit the claim to the insurer with the proper coding and the insurer will pay it. If they try to put it to collections, then say that it is an illegitimate bill and explain why.


I did spoke w/ my insurance and requested to re code the visit and they will pay for it. I been w/ same clinic since 89 and never had any of these problems before the new owners. Having something on my credit report is like asking me if I give a rat ass about it and the answer is no. I am retire and no longer work and if I need or want something I can just pay for it.

 

[The Cosmic Avenger]

I would ask the Illinois Dept. of Insurance if they can help. Even though the issue is with the clinic more than the insurance company, medical providers are often responsive to insurance regulators, since they are somewhat dependent on medical insurance for much of their business. I don't know what Illinois is like, but state regulators in Maryland can and will act as consumer advocates in their areas.

 

[SoClose]

I turned 50 and scheduled a routine colonoscopy which is covered under ACA. I then receive a $5,000 bill [emoji15]

Medical Office says they coded correctly, insurance says nope not a covered code. After three months, several hours and multiple phones calls I was still being denied. The two refused to talk to each other to resolve just pointed fingers that it was the others problem.

I had to file an appeal with insurance, they finally agreed to give me a courtesy onetime correction......OMG, Are you kidding me!

I was NEVER going to pay it. And as a patient had to learn far more about billing codes than I ever should have.

 

[pb4uski]

I'm not sure, but I think that you might be able to find out from the insurer what the correct code is, and then give it to the doctor's office... from there it is up to them if they want to get paid.

It is things like this that make the idea of Medicare for All or some single payer system attractive.

 

[Koolau]

I would assume that some insurance companies routinely make their problem YOUR problem. I would threaten the insurance company with calling the state insurance commission or whatever it's called. YOU HAVE RIGHTS though YMMV.

 

[RetMD21]

The provider can always change the code and rebill. They do it all the time. I don't think that the insurance is obligated to pay miscoded claims although some are fussier than others

 

[HF63]

I spoke with a case manager. I explain to her what the problem was and it was up to her to fixed the billing problem and get pay. I am only giving them my co payment and does all.