<p>I had a brief ER visit a few months ago, and I’ve just received a bill from a doctor who read the (routine) electrocardiogram. The insurance company denied it, saying that it should have been included in the hospital charges (which were paid). Now the doctor’s office is billing me for the full amount. I’ve just received the first bill, and they are calling it “90-120 days overdue.” </p>
<p>There is no phone number on the bill, and at the bottom is printed, “NO PHONE CALLS ACCEPTED.” Very annoying. Clearly, either the charges are valid, and the insurance company should pay, or they are invalid, and no one should pay. How am I supposed to work this out without calling?</p>
<p>Send them a letter telling them that, unfortunately, you won’t be able to pay until having a conversation with their billing department. Include your phone number.</p>
<p>I handle all billing disputes by snail mail so that I have a paper trail to prove what I’ve been told by the ins. co., hospital, etc. Each letter is typically CC:'d to multiple people. I’ve typically written a letter to the ins. co. outlining all facts of the dispute, and copied it to the employee benefits dept. and the medical provider. Most of the time the problem has been that the medical provider’s office failed to properly code the service provided. The exception has been hospitals, which frequently billed for services never received. When I protested directly to them, they could not understand why I cared since my ins. was going to pay (nevermind that for years we had a 20% co-pay, which can really add up when the total bill hits six figures.)</p>
<p>In most of my experiences, the doctor or hospital required me to sign a statement of financial responsibility in which I promised to pay if my ins. did not. When I had a PPO ins. policy and used their contractual providers, I didn’t have to pay anything extra. If my GP sent me to a specialist who wasn’t in the PPO (usually because there wasn’t one in my area), I had to pay the difference. </p>
<p>Good luck! But be prepared for a dispute to take 6 - 8 weeks (if not longer) to get resolved.</p>
<p>I spent more than 20 minutes on the phone with my insurance company. It turns out that the doctor’s office put the wrong date on the claim, and it did not correspond to the ER visit. They are going to reprocess it. </p>
<p>Isn’t there a law that anyone billing you for anything has to provide a phone number? I really don’t want to send them a letter.</p>
<p>Frankly, I would ignore the “NO PHONE CALLS” nonsense, and try to find the phone number by “googling” the doctor’s name.
I always keeps notes of date/time of any important call to Dr.'s office, who I spoke with, what they said, etc.</p>
<p>I did google the doctor, and called his office (with the same address as the one shown on the bill). Their billing office said that my account number was not one of their accounts. Apparently this is his private office and there is a different operation that handles readings from the hospital, and that operation “doesn’t have a phone number,” but she could “get a message to them.” I left a message that included my opinion of their practices. Let’s hope the insurance company comes through and I don’t hear about this again.</p>
<p>I think I will complain to the hospital. They are always concerned about patient satisfaction.</p>
<p>We had the same issue with the firm that provides ER docs to the ER we go to. I wrote a letter on July 5 asking for an explanation why the charge isn’t included in the $400+ ER evaluation fee (and which my insurance company and I happily paid). </p>
<p>I don’t mind paying it…but I want a PERSON to tell me whether it is a valid fee. </p>
<p>I agree - it should be possible to talk to a person. In many cases, claims are denied because of coding or other errors. How can this be straightened out if no one is available to discuss it? The attitude of this doctor seems to be, we will submit once to the insurance company, if they don’t pay, you have to. I understand that I am ultimately responsible, but they should make a good faith effort to straighten out any issues with the claim.</p>
<p>Related (but not the same)…when DD was seen in the ER while in college (and was subsequently admitted to the hospital), we got a FULL bill from the ER doc because he did not participate in Anthem/BCBS. Yes…the hospital did, but the ER doc didn’t…so he was “out of network”. Boy did I pitch a fit. I called and basically told them…that when someone goes to the ER with something serious enough to be admitted, they are not given the option of saying “I need to see a participating Anthem doc”…they are put in a cubicle and get whomever shows up. Anthem paid the bill in full…as they agreed with my assessment. </p>
<p>I found it unbelievable that the ER doctor was not a participating physician with Anthem, but the ER was. I’ll bet lots of folks simply pay the bill. I was not going to do that.</p>
<p>I agree that you should send a letter to the doctor’s office as proof that you’re following up in a timely fashion. Include in that letter your dissatisfaction that you couldn’t call, but in this case it’s really for your benefit anyway. Keep a copy and stick it with your medical bills.</p>
<p>You may discover that they charge you separately for the doctor to read the electrocardiogram. In our area, that’s not unusual. (Hospitals charge for space, doctors charge for medical advice/service.) Your insurance should still pay a percent, but you’ll still owe the balance. Having a copy that letter shows you’re acting in good faith and getting the bill paid.</p>
<p>ETA: it’s in their interest to get this bill paid. If they don’t cooperate, you have that letter as proof that they didn’t help, as they should by sending in the correct information to the insurance. Be sure to state who is responsible to do the next step (which is contact the insurance with the correct information). In my experience, the insurance company is usually much more expedient if they get bills through a doctor’s office than through the policy holder.</p>
<p>I’ve had the exact same issue, thumper. Several years ago S2 went to the ER. The ER doctor, who saw him there, was in a group that was not part of the BC/BS network, although the hospital was. This led to an claim/billing issue that took the better part of a year to resolve.</p>
<p>We had a similar issue related to my mom’s cardiac surgery this spring. It’s often a matter that the hospital itself neglected to include all charges (or do so properly) when they submitted to the insurance company. As a rule, when I encounter this sort of thing, I start with a call to the HOSPITAL billing folks.</p>
<p>OP, surprised the ins co was willing to reprocess based on a conversation with you- perhaps they are going to contact the provider and hospital, for confirmation. I’d think about my own follow up talk with the hospital.</p>
<p>Had a similar incident. My daughter had an out patient MRI and nearly a year later, we received a bill for the 20% copayment for hospital visit. The MRI was not done in the hospital, but because the center is owned by the hospital and they used an improper code that indicated the MRI was inpatient, our insurance company payed 80%. I had already paid several hundred dollars upfront and was not about to pay another $1,000! It took months to get it settled, but they finally fixed the billing code. Oh, and the very first bill I got for this was from a collection agency associated with the hospital!</p>
<p>My issue was solved by the insurance company also…based on my “chat” with them. I never dealt with the doctors office at all.</p>
<p>Here’s another good one…my husband got to ride in the helicopter to the ER (he was also admitted)…our insurance paid the full cost of the ride. TWO years (TWO) later, I got a bill from the Lifestar folks for $3000…ahem…I don’t think so. I called my insurance company and they dealt with it. I never dealt with the helicopter folks at all. I also never found out what happened, but I did get a note saying “paid in full”. Yep.</p>
I find this to be very deceptive on the part of the hospital. You should have every expectation that someone working at the hospital accepts your insurance if the hospital accepts your insurance.</p>
<p>Especially in an emergency situation. What are you supposed to do, ask every person that comes in the room if they take your insurance? And if they don’t, what do you do, kick them out of the room and demand someone else?</p>
<p>DW was in the hospital earlier this year and needed a last-minute cat scan. In the next month we got bills from <em>5</em> different people who looked at the results. It seemed like they were asking everyone with a pulse to look at it. Fortunately, insurance covered them all and only paid them each about $15, and our cost was only the 10% co-pay.</p>
<p>Oh boy - the ER doc not being in network just really gets my BP up into the danger zone! Yup, same thing happened when DD went in to local ER a few years ago. Received separate bill, 6 months later, from a group I had never heard of. Both hospital and Insurance Co. said this is SOP.</p>
<p>On a different visit, DS was an ER facilities user NOT and ER patient. Basically, his in network Dr. was unavailable at the office because he was working an emergency in the ER. The agreement was to have the Dr. see DS in the ER as a private patient, NOT and ER patient. Imagine my surprise when I received a bill from the ER Dr. who ‘saw’ DS. I called the hospital and was assured every patient is ‘triaged’ by and ER. Doc. - no exceptions. I asked to please have a copy of the ‘triage’ evaluation as well as the Dr. name sent to the Dr. that actually treated DS. Funny, never saw another bill. Argh!</p>