About two years ago, I went to the doctors office and he requested that some testing be done. I had and still have the same insurance. A copy of my insurance card was made and the doctor's office sent out the testing and submitted my insurance information along as well. A few months later I got a letter from the place that did the testing, saying my insurance number was not valid, please submit a copy of your insurance card. I did that. Never heard anything, no bills, nothing. Then I got a letter from a collection agency for the full amount. I sent another copy of insurance card to the testing place, but sent it CRRR, so know that they recieved it. Got green card back and then a few weeks later a letter saying no such account exists. Now, I am getting another letter from a collection agency for the full amount. First CA was not bonded or licensed in my state, this new one is. My questions are: 1) consideing the amount of time that has passed, will I be liable for the full amount? 2) why was my insurance not billed, even though correct information providied? 3) Send validation to 1st and 2nd CA and also to provider of services? 4) In these requests, ask for proof of insurance billing and denial? 5) Am I just screwed on this one?
A couple suggestions from someone who goes through this on a regular basis. First, get on the phone with the insurance company and find out what their side of the story is. Were they billed? Did they get billed but declined it, possibly because they needed more info from the testing lab? They do this all the time. It is possible that the lab never got back with them. In other words, find out whose fault this is. My experience is that neither side ever picks up the phone to call the other side. Sometimes they let the claim fall through the cracks. Persistence on your part gets them off their butt. In defense of the lab, I will point out that on many occasions I have sat in a doctors office waiting for approval of something. It is not unusual for the insurer to put the doctor office on hold for 45 minutes or more. I could understand why the lab may not want to call. But, you are liable, so you need to wait on hold to get an answer. If necesary, set up a three way call between you and the lab and the insurer. Find out what needs to be done to get it fixed. Last, my insurer has a policy that if the bill is not submitted to them for payment within six months, they are not liable, and the provider cannot bill the patient. On more than a couple occasions, my provider never got paid because of this. See if your insurer has a similar policy. Sometimes there is a simple answer. It just takes some effort to find out the problem. As an example, my son turned 21 last week. He is still covered under our policy because he is a full time college student and he lives at home. He had a $40 bill from February that the insurer kept rejecting. No reason given. When I called, they said that they never got the bill. When I called the provider, they repeatedly said they had submitted the bill four or five times. I finally called the insurer, refusing to take no for an answer. They finally told me it was rejected because they had no proof that my son was a full time student living at home (even though I had given them this information on other claims for him). When I said he was, they paid. The whole point is to start calling and get some answers. Some insurers won't pay until they are forced to. I have been with great insurers (Prudential and Cigna) who always pay on time. And , I have been with the worst (Healthnet), who will not pay unless you force them to.
But, you are liable, so you need to wait on hold to get an answer. Thomas ++++++++++++++++++++++ =========================== This is just the opposite of what was posted on another thread today. Who Is Rite?
