Insurance/provider billing question (yikes! long!)

[geetey]

I hope this is the right place to post this question. I am guessing that most of you are like me and can run into some issues with providers and billing. I am looking for a website or someone who can help me understand my obligation for a bill.

To make a very long story as short as possible, I had 3 MRIs (with and without contrast) done over 2 days in June 2004. My husband had started a new job and his company provided 'bridge' insurance with a maximum of $1500 in coverage. We also invoked Cobra and paid over $1000 to have double coverage because of my MS diagnosis.

The provider (radiology company) incorrectly billed the BRIDGE insurance first and immediately used up the $1500. Upon my notification, they claim they fixed this problem, billing BCBS as the primary. For over a year following, I filed out numerous Additional Information requests from BCBS and Starbridge, as well as several "do you have secondary insurance" forms and "is this related to an on-the-job injury" forms. I remained in constant contact with all 3 companies. At the end of last year, I paid the Radiology Company $249.39. While I believed we should have had $0 out of pocket expense for this MRIs, based on our double coverage, this seemed an acceptable amount at about 5% of the bill.

Imagine my surprise when over a month ago, I received another bill from radiology saying I am responsible for payment of 1 remaining MRI (they are claiming they have received insurance $$ for only 2 of the procedures). I contacted radiology - they want $1400. I contacted BCBS - they say it has been over a year since the date of service so the claim is invalid. After many phone calls, BCBS did some searching and says they DID receive the claim - not sure what the hold up is - blah blah blah - we will get back to you.

Yesterday I get another bill. Basically radiology wants another $900 from *us* because they didn't file with insurance properly?? BCBS agreed to give them $500. I say I have paid you once (when I should have had $0 out of pocket expense, based on my coverage) because they messed up the order of filing the claim. I want to know if I have any rights in refusing to pay any additional $$ to radiology. I have taken every step to give the necessary information - including faxing and mailing the same forms over and over.

I don't want to have to pay a lawyer but I don't believe this portion is MY responsibility. Any advice or am I stuck because of that standard "You are responsible for this bill regardless of insurance" statement on every release you sign?

I apologize for the length. I am hoping some DISers with more insurance experience might guide me in the right direction.

Thanks!

 

[cymomtx]

Contact your state board of insurance.

 

[shoegirl1020]

I beleive they call that "double-dipping" and it isn't allowed with most Blue Cross plans. If the MRI place accepted BSBC as payment and say the MRi was $1200 and BSBS paid $900 then the MRI center "eats" the balance. I would check with BSBC and see if the MRI place is allowed to try to collect hte balance from you.

 

[momofthreegamers]

The previous poster that commented on 'double dipping' is correct, if the radiology company was a member of the 'network' then the Radiology company can not balance bill you. However, it is not uncommon for a Radiologist to not even belong to a network. Generally speaking, insurance companies will have specific terms regarding how to handle Radiologist claims; they could apply co-insurance to the claim (example - pay 95% of Reasonable and Customary charges.) It really depends on how the plan has been structured. What did BCBS pay on the other MRI's?

You said you had COBRA...could you contact the previous employer's Human Resources department? They are 'usually' a valuble resource.

Also, just because you were double covered does not necessarily mean that you would not have to pay anything out of pocket. 'Coordination of benefits' is different with every plan.

 

[geetey]

Good point, Melissa!

I called BCBS again to have someone pull all of the information together. With just their coverage, they said, including my deductible, my responsibility totals $961. That amount is well under the $1500 coverage from the bridge insurance. The claim rep was very nice and she is sending all of the EOBs to me and Radiology again. I still have my original ones, but she thought this would help. Next step it is contact the bridge insurance and see exactly where their $$ went. In the process of moving, I don't have all of their EOBs, but do show around $650 of payments to radiology.

I guess after all of my ducks are in a better row, I will be contacting Radiology again to try and staighten this out. Unless some of the bridge $$ went to another provider (which I have no statement or bill for), there appears to be some fraud here.

Thanks for the advice!

 

[canwegosoon]

I had something similar, where the bill was not paid for over a year and refused to pay. I think I had to end up contacting my HR department and getting help from them too. I donot know about the double dipping...but think it would be smart to contact your state board of insurance(as cymomtx suggested) and/or also contact your state attorney general.

 

[pounder207]

Don't be is such a hurry to pay them. Unless you're concerned with ongoing coverage with the carrier, they're not going to sue you for this amount of money. I don't know anything about the court system in Missouri, but I know the NY system well. No one is going to sue you and if you don't care about the provider--eg ongong care at the same facility--just ignore any collection attempts. With the price of postage going up, the number of letters they send has gone down.

The carriers screw these things up royally as do the providers. Keep notes of dates, names and correspondence/EOMB's. If you have patience, in the end the providers will give up and go away to easier targets.

 

[geetey]

Thanks pounder. I am in no hurry to give them any more money. I don't have to worry about ongoing care from this Radiology as it is located in TN, our former state. I am just frustrated that over 2 years later they are trying to bill me for something I believed was settled.

Thanks for everyone's advice!

 

[Nurseman]

Don't be is such a hurry to pay them. Unless you're concerned with ongoing coverage with the carrier, they're not going to sue you for this amount of money. I don't know anything about the court system in Missouri, but I know the NY system well. No one is going to sue you and if you don't care about the provider--eg ongong care at the same facility--just ignore any collection attempts. With the price of postage going up, the number of letters they send has gone down.

The carriers screw these things up royally as do the providers. Keep notes of dates, names and correspondence/EOMB's. If you have patience, in the end the providers will give up and go away to easier targets.

This is common wisdom but very bad advice. I have seen people lose their home with the "it's too small to sue me " idea. The medical center will not "give up" they will send it to collections after about 120 days. The collection agency will scar your credit, they will put a lean on your house, call you at work and at home, and call your boss, family members to "find you". Collection agencies do not care about you.
Your affected credit rating will cost you a lot more than the bill in dispute. Consider the higher car payments and car insurance or Credit Card rates. Most people do not realize that your auto / homeowners insurance rate is affected by your credit. The Smear will be on your credit for 7 years - multiply that time by the higher rates you will pay.

You can pay the claim along with a letter that this is under dispute and continue to fight with the insurance company and the provider.

I have worked in Health care operations for years unfortunately I have seen provider mistakes end up costing clients -- at the end of the day you are responsible for your own claim even if the provider screws it up. Your insurance is your responsibility not the providers.

Also there is not rule that the provider must accept consignment (not charge you the balance) it varies with the providers contract with each health plan. It is also not double dipping that is when they bill you for the MRI and then try to bill you for another service charge that the base reimbursement provided by the insurance for the MRI already covers.

 

[geetey]

Thanks for your advice, Nurseman. We have excellent credit and my dh pulls our credit reports on a 4 month cycle (using a free one each time) so no problems there. I would prefer to file a letter with the credit reporting companies that this particular item is under dispute, versus give away my money ahd hope I get it back.

I am understand that my insurance is my responsibility but if I am not given the information to be able to file the claim, what I am supposed to do? I have called countless times - even doing something as simple as correcting my current address!

Can you explain your last paragraph for me? Both of my insurances have/had an agreement with this provider. BCBS's network savings averaged $525 per MRI. Bridge's network savings averaged $265 but I wasn't even 'counting' that against what I feel is my responsibility. The EOB clearly states what is the Patient Responsibilty. The provider is trying to get *more* than that.

Color me confused and thank you for your help! I really am trying to figure this whole mess out.

 

[geetey]

I am sure I am coming across even more blonde than I am, but after some digging and getting those old EOBs in hand, I see that Radiology received payment of $1144 from Bridge and $986.62 from BCBS for a single $1800 MRI. Since that totals $2130.62 on my calculator, isn't that double dipping??

 

[pounder207]

Sounds like they recovered more than the total bill. Always check the EOMB's.

Not to disregard Nurseman, no creditor can put a lien on your house without first suing and obtaining judgment(except mechanics liens). Doctors don't sue, and if they do, they don't come to court to prove their cases. Medical facilities may but they generally don't(at least in NY). The calls from collection agencies to you and yours cease upon receipt of a letter from an attorney that you are represented and no longer wish any contact from them. If they don't comply, there are extraordinarily heavy penalties under the FCCA.

 

[Nurseman]

Doctors don't sue or have to show up in court they turn the receivable over to a collection agency to do it for them. Yes it requires a judgment and court order to go after assets but that is what collection agencies do for a living. They will go to court they will get the order. You are responsible for your medical bills not your insurance, the court will approve it without question. Hiding from creditors never works. Also the collection agency will not stop calling because your attorney sent a letter - they will just call your laywer who will bill you $$$$ for the call - not a good solution.
Check out the FDC website for more information.



BTW - Having a comment on your credit report is near worthless since most companies don't actually read the credit report. They get a credit rating company to assign you a score FICO score for real estate - MC and visa cards, auto loans, insurance use different scoring systems. You score will be lowered and most of the time they will never read the report. You have great credit so you are risking a lot by not paying this bill. Do a search under credit and credit scores for more infromation.

 

[pounder207]

With all due respect to Nurseman, I've been a lawyer for more than 30 years. Collection agencies don't go to court because they can testify to nothing. That's what hearsay is all about. No judge I've ever known has granted a judgment "without question" if you appear in the action and answer the complaint. Nor can collection agencies call you once a day if your attorney has notified the agency that you are represented by counsel and you wish no further communication from them. As a lawyer you never waste time talking to collection agencies. You have your staff tell them to put all claims in writing together with all backup material. Collection agencies generally don't have that material so they can never send anything meaningful. And the answer then becomes, well if you can't provide it, your attorney will have to during discovery. Attorneys who do collection work do so on a percentage. No one is interested in wasting time for a third or half of little to nothing.

And, oh yes, you definitely can avoid creditors who are trying to collect relatively nominal sums of money.

However, it sounds as though the provider here has submitted more than one claim for the same procedure to different carriers and received more than the total cost of the procedure. Doesn't sound like your problem to me.

 

[clkelley]

Also, if the collection proceedings do start to get nasty, send them $1. If they cash that $1 check, then start sending them $1 each month. They can't do anything else to your credit at that point, because by cashing that first check, they agreed to a payment plan of $1 per month.

 

[momofthreegamers]

I am sure I am coming across even more blonde than I am, but after some digging and getting those old EOBs in hand, I see that Radiology received payment of $1144 from Bridge and $986.62 from BCBS for a single $1800 MRI. Since that totals $2130.62 on my calculator, isn't that double dipping??

This is not uncommon. This could have happened because they billed Bridge first, then billed BCBS. Does your Bridge insurance now that they are not primary? It is possible that your Bridge insurance could have done a reversal on the payment once they know they are not primary. I would check with Radiology to see if that happened. They could tell you if they actually rec'd 2130.62.