Author Topic: Help with insurance/doctor bill  (Read 1642 times)

FastStache

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Help with insurance/doctor bill
« on: January 03, 2014, 07:19:58 PM »
I have two very similar surgeries in 2012. I just got a bill from my doctor which was very surprising as I paid everything in as it showed up back in 2012. The bill date is late December 2013.

The surgery I had in September 2012 was fully approved no issues. The one in November 2012 is the one the insurance did not fully pay for. I assumed everything was fine as I had no remaining bills and looking at my insurance claims online nothing was showing outstanding. Now that I see this bill I see they didn't cover one portion of the surgery, and have a note that I don't have to pay it.

What do I need to do proceeding forward? The bill is over 2K and I really don't want to pay it as the insurance should have covered it.

MKinVA

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Re: Help with insurance/doctor bill
« Reply #1 on: January 03, 2014, 07:27:03 PM »
Ask the doctor in writing to resubmit the bill to the insurance company and send the insurance company the bill yourself and ask for an investigation. Doctors, hospitals seem to send bills to collections before the time runs out to get payment from the insurance company. Sometimes the payments cross in the mail, so to speak.

Indio

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Re: Help with insurance/doctor bill
« Reply #2 on: January 03, 2014, 08:09:53 PM »
I had a problem with a doctor bill and the doc office didn't code it properly so I was being charged when it should have been covered by insurance. You should definitely call to make sure there wasn't some human error that happened here.

minkcar

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Re: Help with insurance/doctor bill
« Reply #3 on: January 04, 2014, 12:25:00 AM »
I work in healthcare IT, and eat lunch with some of the guys who maintain our billing systems.  I don't understand the whole billing process (it seems like black magic), but I know a bit about how it works.

The insurance would have been billed for both services, and they will check that all the paperwork is in a row before sending payment.  You generally will not be charged any of your portion until after the payment from the insurance company has cleared.  Usually that's within 30 days of the service.  If, however, the pre-authorization number wasn't entered right, or the insurer didn't think the provider picked a specific enough ICD-9 code (out of 13,000 codes) they'll deny the claim, and the bill has to be re-sent with updated documentation, etc.  They may request an audit of the whole record.  I've heard of those bouncing back and forth for up to 2 years.  Then it finally gets through insurance (with lots of room for human error), and they come back and bill the patient.  I can imagine a scenario where the insurance company thinks it's in the hospital's court (so they show nothing outstanding), and the hospital takes 2-3 weeks to gather additional documentation to justify their charges.

I would check to be sure which date of service (September or November) the bill is on, and double-check that you didn't accidentally get billed twice.  Check with every party involved (anesthesiologist, surgeon, hospital, insurer, etc.).  Be kind, but require full and detailed documentation of exactly what happened, where all charges came from, and what was paid.  If something was hanging out in limbo for a full year they should be able to provide you with details as to how much and why.

Good luck!