Jump to content

Medical Bill not submitted to Medicare for payment, then turned over to CA for non payment


myscoresawful
 Share

Recommended Posts

Simply put, a visit to the ER incurred a bill by a radiologist who did not file with Medicare (although the hospital and all other medical expenses did).  I wrote them pointing this out, but they never replied and now I see it popped up on my CR as a collection.

 

Are they required by law to file with any insurance you have, including Medicare, before hiring a CA and/or reporting you to the CRAs?  I am POSITIVE Medicare would have paid, I just don't understand why it wasn't filed.  There is no way that I could have contacted Medicare and had them pay this without them receiving something from the Radiologist to pay.  I would add that Medicare costs me over $100.00 a month to have and is not given to me.  There is no reason why I should have to pay a medical expense when I'm already paying for insurance that COVERS that expense?

 

Any help in how to approach this would be greatly appreciated. 

Link to comment
Share on other sites

Are they required by law to file with any insurance you have, including Medicare, before hiring a CA and/or reporting you to the CRAs?  

 

No.  There is no law that requires any provider to file your insurance for you.  In fact most providers have a statement in their financial guarantee that you sign (some even have a sign hanging as well) stating that they file insurance as a courtesy to the patient but it does not change the fact that the patient is ultimately responsible for the bill.

 

I am POSITIVE Medicare would have paid, I just don't understand why it wasn't filed.  

 

Most likely because the radiologist does not participate in Medicare.  Physicians are not required to participate in Medicare or Medicaid.  If they are not a participating provider then you have to pay 100% of the bill and get CMS to reimburse you.  The majority of radiologists are contractors to hospitals for their services so their billing would be entirely separate and the hospital being a Medicare participant does not mean their contractors automatically are.

 

There is no reason why I should have to pay a medical expense when I'm already paying for insurance that COVERS that expense?

 

 

Insurance provides some protection/help with medical expenses but it is not a 100% blanket coverage.  Especially Medicare.  If the provider is not a participant in the program then it isn't covered for payment direct to the provider.  You must pay the charge yourself and get reimbursed.  Due to severe cutbacks in reimbursement along with the draconian process to get paid not to mention become a provider many physicians and clinics decline to participate or have stopped all together.

 

Medical bills are ripe for pay for delete from credit reports.  Write to the collection agency and ask for validation.  Then make an offer to pay for delete from your report.  Depending on how long ago this happened it may be too late to file a claim with Medicare.  Their time limit to file has been drastically cut along with their payments.

Link to comment
Share on other sites

Clydesmom, thank you so much for this information.  I will do further checking and see what I can find out, but I guess it's pointless as to whether or not they participate in Medicare because even if they do, they don't have to file?

 

It would have been nice of them to just say they don't participate (if that is the case) instead of sending it to collections.  I never received anything else from any of the other physicians because Medicare paid everything and those doctors accepted what Medicare paid.

 

I never even received anything from the CA, it was my credit monitoring that gave me a heads up.

 

I will try the PFD first and hope for the best. 

Link to comment
Share on other sites

Clydesmom, thank you so much for this information.  I will do further checking and see what I can find out, but I guess it's pointless as to whether or not they participate in Medicare because even if they do, they don't have to file?

 

It would have been nice of them to just say they don't participate (if that is the case) instead of sending it to collections.  I never received anything else from any of the other physicians because Medicare paid everything and those doctors accepted what Medicare paid.

 

I never even received anything from the CA, it was my credit monitoring that gave me a heads up.

 

I will try the PFD first and hope for the best. 

 

Call the radiologist billing office and ask to speak to them.  They may not have ever received your letter.  Medical debt is the one time that you do want to speak to them about what is going on.  Many times it can be solved over the phone.  How long ago was the bill?  

Link to comment
Share on other sites

A little over a year ago. Actually, come to think of it, I just received a statement from the VA also that they had paid some of these (takes them awhile, I guess.  To pay private hospital bills).  I never thought about checking to see if it is broken down in that.  The hospital's billing department knew to bill the VA, but I suppose doctors can 'not participate' with the VA also?  

 

Let me find that statement.  It just came in the mail about a week or two ago.

Link to comment
Share on other sites

it's not actually a case of using doctors contracted by the VA. The VA will pay private doctors/hospitals (not contracted or affiliated with the VA) in certain cases, especially emergency situations for healthcare of veterans with service connected disabilities.  The hospital and other doctors were not contracted by them either, and they were paid.  I am wondering if the billing department somehow missed this radiologist when providing my information to the treating doctors of that visit?  I would still think their office would have at least let me know a payment had not been received.

Link to comment
Share on other sites

I am wondering if the billing department somehow missed this radiologist when providing my information to the treating doctors of that visit?  I would still think their office would have at least let me know a payment had not been received.

 

Possibly but yes, they should have billed you.  Hence the reason to have a conversation and make sure they have all your correct information.

 

I had surgery several years back and out of the blue several months later got a notice from anesthesia I owed $900.  I thought this odd and checked my EOMBs from my insurance and sure enough:  no claim ever submitted.  I called their billing and they said my insurance didn't pay.  Don't know how or why but they did not have my insurance information.  I have NO idea whose policy information it was but no wonder it was denied.  They took my information and lo and behold after insurance paid I only owed $35.  Big difference.

 

Call and speak to someone and sort out what went wrong.

Link to comment
Share on other sites

Possibly but yes, they should have billed you.  Hence the reason to have a conversation and make sure they have all your correct information.

 

I had surgery several years back and out of the blue several months later got a notice from anesthesia I owed $900.  I thought this odd and checked my EOMBs from my insurance and sure enough:  no claim ever submitted.  I called their billing and they said my insurance didn't pay.  Don't know how or why but they did not have my insurance information.  I have NO idea whose policy information it was but no wonder it was denied.  They took my information and lo and behold after insurance paid I only owed $35.  Big difference.

 

Call and speak to someone and sort out what went wrong.

 

(that's hilarious :) )

I intend to do that either way, but I am now turning my 'filing box' upside down looking for that statement from the VA.   I guess it doesn't really matter if the VA paid it or not at this point, it's on my report and the best I could hope for if it is paid, is that it was PIF.  If not, then I'm definitely going in for the PFD move.  

 

Thanks again!

Link to comment
Share on other sites

Ok, update.  The name of the OC on the collection report is a little misleading.  This bill is for the ER doctor at the hospital.  (I went to one ER, and that doctor transferred me by ambulance to a bigger hospital).  Between the VA and Medicare, the ambulance and everyone at the second hospital was paid with no money out of my pocket. I know I wasn't at the first hospital very long and only saw the ER doctor and 2 nurses.  I don't know where the break down on my information of coverage fell, but I'm pretty sure there is no way ER doctors could not accept Medicare??  I mean, how could a hospital put your emergency in a "cash/selective insurance only" situation? 

Link to comment
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

 Share

×
×
  • Create New...

Important Information

We have placed cookies on your device to help make this website better. You can adjust your cookie settings, otherwise we'll assume you're okay to continue.. For more information, please see our Privacy Policy and Terms of Use.