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Medical Billing Dispute
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Author:  BigW72 [ Fri Jun 12, 2015 11:29 am ]
Post subject:  Medical Billing Dispute

Need your expert help here...

My ex-wife had surgery to repair torn MCL back in March 2013. At this point I had already filed for divorce so she made sure she had the surgery done to ensure it went under my coverage and I was on the hook to cover expenses....not going to cry about that. I had paid what I thought was everything related to the surgery.

Fast forward over a year later and she starts getting billed for $705 from the facility that hosted the surgery. We seriously never saw a bill until over a year later! The insurance didn't get the bill until that time as well, so it wasn't something the insurance company screwed up.

Do I have any case to dispute based on them not billing for so long?

Author:  IMU [ Fri Jun 12, 2015 11:38 am ]
Post subject:  Re: Medical Billing Dispute

Yes. Timely filing dispute. You should not be responsible for this. The provider needs to prove to the insurance company that it was filed in a timely manner. If they can do this, the insurance needs to process it, and you pay per your deductible / co-insurance. If the provider cannot prove this, they need to write it off.

If you have BCBS, Humana, or Aetna...they are very good at tracking down past claims that were filed.

If you have UHC or a few of the smaller guys...they are more prone to mistakes.

Either way, very unlikely you will need to pay...just will take several phone calls.

I did medical billing for six years.

edit: Unless the insurance documents were not properly provided to the facility. While many hospitals / PCP's do forward insurance info to all facilities, it is not their responsibility. Your ex-wife would have needed to make sure she provided a copy of the insurance card to the facility. This would be the provider's argument if they try to dispute timely filing. You / your ex-wife would then need to contact all the providers involved and make sure someone (your wife or them) provided insurance information.

Does the insurance company even show a coverage / benefits check from this provider a few days before the scheduled procedure?

Author:  IkeSouth [ Fri Jun 12, 2015 11:50 am ]
Post subject:  Re: Medical Billing Dispute

this is why i love my obamacare. i just call the irs and tell them to fuck off and i dont have to pay shit

Author:  SomeGuy [ Fri Jun 12, 2015 12:03 pm ]
Post subject:  Re: Medical Billing Dispute

IkeSouth wrote:
this is why i love my obamacare. i just call the irs and tell them to fuck off and i dont have to pay shit


Ah the perks of being an unemployable pied of shit.

Author:  IkeSouth [ Fri Jun 12, 2015 12:14 pm ]
Post subject:  Re: Medical Billing Dispute

SomeGuy wrote:
IkeSouth wrote:
this is why i love my obamacare. i just call the irs and tell them to fuck off and i dont have to pay shit


Ah the perks of being an unemployable pied of shit.


pied of shit? also, i had obamacare when i was employed, cocklover

Author:  Seacrest [ Fri Jun 12, 2015 12:22 pm ]
Post subject:  Re: Medical Billing Dispute

IkeSouth wrote:
SomeGuy wrote:
IkeSouth wrote:
this is why i love my obamacare. i just call the irs and tell them to fuck off and i dont have to pay shit


Ah the perks of being an unemployable pied of shit.


pied of shit? also, i had obamacare when i was employed, cocklover


Don't put up with that shit Ike.

Author:  BigW72 [ Fri Jun 12, 2015 12:46 pm ]
Post subject:  Re: Medical Billing Dispute

Aetna....they actually paid their portion. They didn't receive it until 14 months after the fact.

it's now in collections, so I'm not sure what to do, but I don't feel I should have to pay. I'd never to a job and show up 14 months later with an invoice for the first time.

Author:  IMU [ Fri Jun 12, 2015 12:50 pm ]
Post subject:  Re: Medical Billing Dispute

wdelaney72 wrote:
Aetna....they actually paid their portion. They didn't receive it until 14 months after the fact.

it's now in collections, so I'm not sure what to do, but I don't feel I should have to pay. I'd never to a job and show up 14 months later with an invoice for the first time.

Hmm...if Aetna received and paid the claim, you would have received an EOB. This would have notified you that a bill was likely coming. Also, it is fairly easy for provider billing departments and outsourced billing offices to 'prove' they've attempted to contact you with the amount you owed.

You might be SOL on this one.

However, even if it is a "bad debt 1" level collections (nothing reported against you yet, all talk but nothing to back it up) they'd likely settle for 50%. Tell them you'll pay $250 to settle it, and negotiate from there. Again...may take a few phone calls. They'll threaten to put it against your credit, but medical bills are removed from credit reports once paid, and do not leave a lasting mark once paid.

(Each provider usually has a couple of agencies working with them. What starts as a bad debt 1 with one agency will be transferred to another agency upon reaching bad debt 2 [outstanding for xx amount of months longer]. When a debt is transferred after that agreed upon time frame, the first agency would no longer get their commission. So they have a desire to settle the debts before they are transferred out.)

Author:  SomeGuy [ Fri Jun 12, 2015 1:02 pm ]
Post subject:  Re: Medical Billing Dispute

IkeSouth wrote:
SomeGuy wrote:
IkeSouth wrote:
this is why i love my obamacare. i just call the irs and tell them to fuck off and i dont have to pay shit


Ah the perks of being an unemployable pied of shit.


pied of shit? also, i had obamacare when i was employed, cocklover


And now you're not employed...because you were fired....again. Weren't you supposed to be sucking dick for drugs in L.A. by now or did you fuck that up too?

Maybe next time, Ike.

Author:  billypootons [ Fri Jun 12, 2015 3:10 pm ]
Post subject:  Re: Medical Billing Dispute

figure out their appeal process and get going with it.

Author:  Douchebag [ Fri Jun 12, 2015 3:57 pm ]
Post subject:  Re: Medical Billing Dispute

Just write it off.

Author:  Gloopan Kuratz [ Fri Jun 12, 2015 4:24 pm ]
Post subject:  Re: Medical Billing Dispute

Tell them you paid You have a cancelled check. Number 1329. Get all huffy about it.

If it took them this long to bill you, they must be all screwed up and wont know the difference.

Author:  IMU [ Fri Jun 12, 2015 4:32 pm ]
Post subject:  Re: Medical Billing Dispute

Gloopan Kuratz wrote:
Tell them you paid You have a cancelled check. Number 1329. Get all huffy about it.

If it took them this long to bill you, they must be all screwed up and wont know the difference.

Patients tried this all the time. Never worked.

Author:  IkeSouth [ Fri Jun 12, 2015 6:04 pm ]
Post subject:  Re: Medical Billing Dispute

SomeGuy wrote:
And now you're not employed...because you were fired....again. Weren't you supposed to be sucking dick for drugs in L.A. by now or did you fuck that up too?

Maybe next time, Ike.


just because your dogs wont lick your balls anymore doesnt mean you have to be mean to people

Author:  Chus [ Fri Jun 12, 2015 6:09 pm ]
Post subject:  Re: Medical Billing Dispute

IkeSouth wrote:
SomeGuy wrote:
And now you're not employed...because you were fired....again. Weren't you supposed to be sucking dick for drugs in L.A. by now or did you fuck that up too?

Maybe next time, Ike.


just because your dogs wont lick your balls anymore doesnt mean you have to be mean to people


Image

Author:  Scooter [ Fri Jun 12, 2015 8:16 pm ]
Post subject:  Re: Medical Billing Dispute

IMU wrote:
Yes. Timely filing dispute. You should not be responsible for this. The provider needs to prove to the insurance company that it was filed in a timely manner. If they can do this, the insurance needs to process it, and you pay per your deductible / co-insurance. If the provider cannot prove this, they need to write it off.

If you have BCBS, Humana, or Aetna...they are very good at tracking down past claims that were filed.

If you have UHC or a few of the smaller guys...they are more prone to mistakes.

Either way, very unlikely you will need to pay...just will take several phone calls.

I did medical billing for six years.

edit: Unless the insurance documents were not properly provided to the facility. While many hospitals / PCP's do forward insurance info to all facilities, it is not their responsibility. Your ex-wife would have needed to make sure she provided a copy of the insurance card to the facility. This would be the provider's argument if they try to dispute timely filing. You / your ex-wife would then need to contact all the providers involved and make sure someone (your wife or them) provided insurance information.

Does the insurance company even show a coverage / benefits check from this provider a few days before the scheduled procedure?

This is correct.

Author:  IkeSouth [ Fri Jun 12, 2015 8:29 pm ]
Post subject:  Re: Medical Billing Dispute

Chus wrote:

Image


someguy prefers extra nutty kind
Image

Author:  SomeGuy [ Fri Jun 12, 2015 8:48 pm ]
Post subject:  Re: Medical Billing Dispute

Crunchy is awesome.

Give it to me hard and thick!

Author:  IkeSouth [ Fri Jun 12, 2015 8:56 pm ]
Post subject:  Re: Medical Billing Dispute

you would you gay ass beastiality fuck

Author:  SomeGuy [ Fri Jun 12, 2015 9:05 pm ]
Post subject:  Re: Medical Billing Dispute

IkeSouth wrote:
you would you gay ass beastiality fuck


More violent homophobia from Ike.

Say it ain't so!

Author:  IkeSouth [ Fri Jun 12, 2015 9:20 pm ]
Post subject:  Re: Medical Billing Dispute

Ill fuck u in the ass homo

Author:  BigW72 [ Thu Jul 16, 2015 11:30 am ]
Post subject:  Re: Medical Billing Dispute

IMU...or anyone else,

I told the collection firm I wanted to dispute the bill. I also said I would settle it for $300 (current balance states $786.40). We had not heard anything for quite a bit so called the collection firm back for an update. They said since it's in dispute, it goes back to the medial provider and the effort to collect is on hold. Interesting.

Question is....do I just sit on this or wait to hear from the medical provider?

Author:  IMU [ Thu Jul 16, 2015 1:20 pm ]
Post subject:  Re: Medical Billing Dispute

wdelaney72 wrote:
IMU...or anyone else,

I told the collection firm I wanted to dispute the bill. I also said I would settle it for $300 (current balance states $786.40). We had not heard anything for quite a bit so called the collection firm back for an update. They said since it's in dispute, it goes back to the medial provider and the effort to collect is on hold. Interesting.

Question is....do I just sit on this or wait to hear from the medical provider?

I would follow up with the medical provider / collection agency every couple of weeks. No need to call daily. The collections effort was put on hold (and I'm assuming, not even reported against you yet) so until you hear back from them, you should do okay. But following up never hurts.

Providers are hit and miss at researching unpaid insurance claims. Depends on which billing lady (or man) was assigned your bill, and how much they like their job. If they come back and say it is taken care of, you'll want to call your insurance to confirm. If they state the insurance is still not paying, all is not lost. You just need more details and to further discuss it with your insurance company.

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