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Kara
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Member since 3/07 13217 total posts
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They call me "Tater Salad"
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medical / insurance billing question (related to billing, not health)
PLEASE DO NOT QUOTE THIS POST!! IT WILL BE REMOVED EVENTUALLY!
More than 2 years ago, DH made a trip to the ER for an illness. Yesterday, he received a letter from his health insurance company stating that the ER doctors billed the insurance company after the claims period ended and so DH will be responsible for $x. Granted, this was just a letter from the insurance co., not a bill from the doctors. (We haven't gotten a bill for this amount from them.)
Has this ever happened to someone else? I understand that the insurance company doesn't have to pay the claim if it was submitted late, but why should DH be responsible for paying that to the doctor? Isn't that the doctor's fault? I mean, it's been well over two years since this ER visit.
Granted, we didn't get a bill from the doctors, but if we do... would you call the doctors and complain? It's not a huge amount, but it's enough to make me inquire why WE have to pay it.
FWIW, though really not related, DH has different insurance now.
Can someone in the know just explain to me how this works so I know if we really have to pay it or not? We will if we have to, of course, but I don't understand how this happened...
Message edited 4/4/2008 1:24:04 PM.
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Posted 4/4/08 12:13 PM  |
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JenMarie
One day at a time
Member since 11/07 7397 total posts
Name:
Jennifer
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Re: medical / insurance billing question (related to billing, not health)
If you do get a bill, which I doubt you will, then call the billing office for the doctor (it may be an outside company) and usually they will adjust it off. There's no reason you should have to pay for someone's incompetence.
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| Posted 4/4/08 12:25 PM |
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MsMBV
:P
Member since 5/05 28602 total posts
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Me
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Re: medical / insurance billing question (related to billing, not health)
Posted by Jennifer907
If you do get a bill, which I doubt you will, then call the billing office for the doctor (it may be an outside company) and usually they will adjust it off. There's no reason you should have to pay for someone's incompetence.
ITA. We just had a similar problem recently. The anesthesiologist for a procedure that DH had 4 years ago just sent us a bill. We fought it & won. They were participating in our plan (we never go out of network) and so was the hospital. It was not our responsibility to file the claim.
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| Posted 4/4/08 12:32 PM |
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Kara
Now Zagat Rated!
Member since 3/07 13217 total posts
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They call me "Tater Salad"
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Re: medical / insurance billing question (related to billing, not health)
Thanks, guys! This was my initial thought as well, but I'm not entirely well-versed in insurance claims, etc. I didn't want to make a big stink to find out we really are the ones responsible.
I'm hoping we just won't get a bill, but we will definitely take it up with the doctor's office if we do.
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| Posted 4/4/08 12:35 PM |
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MsMBV
:P
Member since 5/05 28602 total posts
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Me
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Re: medical / insurance billing question (related to billing, not health)
Posted by Kara
Thanks, guys! This was my initial thought as well, but I'm not entirely well-versed in insurance claims, etc. I didn't want to make a big stink to find out we really are the ones responsible.
I'm hoping we just won't get a bill, but we will definitely take it up with the doctor's office if we do.
Every plan is different, but I am pretty sure that if the Dr/Office is participating in the plan it is understood that they file the claims.
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| Posted 4/4/08 12:38 PM |
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LFitzy79
can hardly wait
Member since 5/05 2650 total posts
Name:
Lauren
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Re: medical / insurance billing question (related to billing, not health)
the doctors office has 180 days to bill the insurance company (timely filing). if they don't and it gets denied, then you're not responsible-it's thier error.
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| Posted 4/4/08 12:41 PM |
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dm24angel
Happiness
Member since 5/05 34581 total posts
Name:
Donna
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Re: medical / insurance billing question (related to billing, not health)
Ok heres how it works ( I worked for yrs in insurnace)
IF they Dr is a non participating Dr with your insurance, you call the insuranc e( a...to find out and b..to resolve) ...If he is not, you tell them you had no choice over the dr, he billed past the claims accpetance date and you want claim to show no patient responsibility.
If the Dr. IS participating with your insurance, then they are responsible for submitting and the insurance company made an error in holding you responsibile.
You can FM me if you need me to explain what to say but DO NOT just wait it out. I have seen credits get screwed up over things like this.
IT will nto resolve itself.
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| Posted 4/4/08 12:51 PM |
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EckoRed81504
We are complete <3
Member since 12/07 6299 total posts
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April
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Re: medical / insurance billing question (related to billing, not health)
The actual visit to the er is covered, but the ER DOCTOR isn't.
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| Posted 4/4/08 12:57 PM |
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lilacwine
only love...
Member since 5/05 2034 total posts
Name:
<3
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Re: medical / insurance billing question (related to billing, not health)
I had an ER radiologist (Southside Hospital) send me to collections on a bill a)they never sent and b) wasn't my responsibility. 
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| Posted 4/4/08 1:11 PM |
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Kara
Now Zagat Rated!
Member since 3/07 13217 total posts
Name:
They call me "Tater Salad"
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Re: medical / insurance billing question (related to billing, not health)
Posted by dm24angel
Ok heres how it works ( I worked for yrs in insurnace)
IF they Dr is a non participating Dr with your insurance, you call the insuranc e( a...to find out and b..to resolve) ...If he is not, you tell them you had no choice over the dr, he billed past the claims accpetance date and you want claim to show no patient responsibility.
If the Dr. IS participating with your insurance, then they are responsible for submitting and the insurance company made an error in holding you responsibile.
You can FM me if you need me to explain what to say but DO NOT just wait it out. I have seen credits get screwed up over things like this.
IT will nto resolve itself.
But the letter from insurance indicated that it was NOT a bill and that we were not responsible to the insurance company (at least how I read it). We still need to contact the insurance company about it?
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| Posted 4/4/08 1:19 PM |
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Kara
Now Zagat Rated!
Member since 3/07 13217 total posts
Name:
They call me "Tater Salad"
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Re: medical / insurance billing question (related to billing, not health)
Posted by EckoRed81504
The actual visit to the er is covered, but the ER DOCTOR isn't.
It's not an issue of what is or isn't covered. It's that what SHOULD be covered isn't being covered b/c the doctor didn't submit the claim in a timely manner.
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| Posted 4/4/08 1:20 PM |
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Kara
Now Zagat Rated!
Member since 3/07 13217 total posts
Name:
They call me "Tater Salad"
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Re: medical / insurance billing question (related to billing, not health)
dm24angel -- you have FM. 
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| Posted 4/4/08 1:24 PM |
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MsMBV
:P
Member since 5/05 28602 total posts
Name:
Me
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Re: medical / insurance billing question (related to billing, not health)
Posted by Kara
But the letter from insurance indicated that it was NOT a bill and that we were not responsible to the insurance company (at least how I read it). We still need to contact the insurance company about it?
Donna is definitely the expert, but in my past experiences, when the statement from the insurance company states that there is no patient responsibility, I have never had to pay regardless of how the claim was filed (or not) by the office.
I hope you can resolve this, what an annoying thing to have to worry about.
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| Posted 4/4/08 1:27 PM |
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