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Blinkybambam

Issue with insurance company and medical debt

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Hi,

 

Last summer, I went to the ER and was billed for three services - the ER facility fee, the ER doctor's fee, and the fee for the CT scan I received. My insurance paid the ER facility and ER doctor's fees, but did not pay for the CT scan. My insurance company covers almost everything, and they've never denied a claim before - they're stating that they have never even received the claim for the CT scan, and therefore certainly didn't deny it.

I discovered this after it was posted to my CR by a JDB. I contacted the JDB, and they agreed to remove it for 60 days but would place it back on my CR if the bill was not paid by that point. The JDB also stated that they would contact the radiology firm and ask them to *correctly* bill it to my insurance company. I've asked the JDB to send me a copy of the bill so I can attempt to send it to my insurance company to have it rebilled, but they've not sent one to me.

 

The issue is, I'm certain that the radiology firm incorrectly billed my insurance company, and they essentially refuse to rebill them or give me a copy of my statement so that I could have the opportunity to either pay it or send it to my insurance company for reconsideration. I've asked the JDB and the radiology firm (had to email them as they don't have a public phone number) to resubmit the bill to my insurance, but they're both essentially playing dumb and saying that it was declined by my insurance - which again, even if was declined, there's no reason why they can't resubmit it - they're really making it difficult for me and I'm not sure what to do at this point. It's the only negative thing on my CR and I'm really upset about it as all it would take was a simple rebilling to get this situation resolved. Advice?

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Go to the radiology office and talk to the office manager requesting the files and bills from that day would be a good first step. They you can send those to the insurance company. Also, see if you can pay the bill and the insurance company will reimburse you. That would stop the damage.

 

This sounds like an incompetent office manager rather than any issue with the doctors. I would not say that to the firm but if the office manager refuses to cooperate, you might be able to request to discuss with the doctors directly. Yes, the can resubmit but it is too much work for the office manager apparently and I would mention to the doctor that their employee is causing you grief and issues that should not happen.

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WHocares gave some good suggestions. Another angle, aside from contacting the manager of the Radiology practice in person, is to head straight to the Hospital's patient advocacy office, or the financial services office. I would start with the former, since it sounds like the CT was done in-house -and even if the radiologists reading the scans are located in Timbuktu, the hospital contracts with them and therefore have a vested interest in how they are treating, and/or not cooperating with patients.  I guarantee you that the radiologists have a phone for the hospital to contact them...and that they will answer it! So, have personnel from the hospital reach out.

 

Either way, I would take swift action like that to get the bill resubmitted, since who knows if they can even resubmit at this point due to a potential denial for OTF "out of timely filing"

 

Just be really nice to all, since you never know where the mistake occurred...there are "training problems" on both sides of the fence -it could be a failure on the insurance side... you just never know -so keep blame out of it to produce results. Good luck!

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