What Do I Do If I Was Charged for Covered Services?
I had a blood screening done at an urgent care facility and a wellness visit at my primary care providers office. Both are in network and my insurance company says there is no charge for this service. I was billed by both the urgent care facility and my doctor. Its been three months and after dozens of calls and emails the clinic and insurance carrier and three personal visits to the doctors office the insurance company still has not paid the bills. Is their a governmental agency that I can complain to ?
On a side note the insurance company claims the urgent care never submitted the bill and the Urgent care billing center at last contact says they submitted it twice and would have to call the carrier again. My insurance company says my doctor submitted the bill but it was coded as sick visit.The doctors office on first contact referred me to their billing department who then referred me back to the doctors office. I asked them to correct it but I got another bill a few weeks later. I went to see them again and the office manager said she would have the doctor correct the code when he returned from vacation. Last week the parent company of the doctors office called me wanting to know why I have not paid the bill.
This just does not seem right to me. What do you think?
Answer
If you are charged for covered in-network services not subject to cost sharing. Don't pay, call your insurer and healthcare provider and have them recode and resubmit the bill to the insurer.
Sometimes it can be something simple, like you are paying the out-of-pocket your cost sharing amount because you haven't met your deductible (ie. it wasn't actually a free service, but rather just a covered benefit). Other times, it is simply a billing, claims, or coding issue. The best way to confirm is to call your insurer and healthcare provider and clarify that the treatment was covered and that it was coded and submitted correctly to the insurer.
If you have called and are still having issues (like in your case), this is annoying but you still should not pay. Rather you should explain to the provider what is happening and have them resubmit the bill (yet again) with the correct coding to the insurer. Billing and claims is it's own whole ball of wax, don't give up when faced with issues. If your plan covers a service then you shouldn't be paying the insurers share of the costs, even in a scenario like this. Make sure to call and coordinate a solution to avoid a bill going to collections.
For filing complaints you should search for "health insurance complaints department in X state" or something to that effect. Health insurance issues are addressed at a state level.
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