Medical Insurance Claim Denied - Can I Do This?

[disny_luvr]

In October I took my son to a local urgent care office because he was complaining of an ear ache (which he did have a double ear infection). Anyway, I accidentally gave my old insurance card (we switched from my health insurance plan to my DH's health insurance plan on September 1, 2011). This week I received a bill for $108 because the claim was denied, which obviously it would be because the doctor's office sent the claim to the old insurance company. I am thinking that maybe tomorrow I will call the urgent care office and give them our new health insurance info and see if they can resubmit the claim to the correct insurance company. Can I even do this? I feel so stupid that I did this in the first place. I really don't want to have to pay the $108 if our insurance will pay it for us. One other thought: I paid a $20 co-pay for this visit but with the new insurance the co-pay should only have been $10. Will I get that $10 back?

TIA!

 

[Marionnette]

In October I took my son to a local urgent care office because he was complaining of an ear ache (which he did have a double ear infection). Anyway, I accidentally gave my old insurance card (we switched from my health insurance plan to my DH's health insurance plan on September 1, 2011). This week I received a bill for $108 because the claim was denied, which obviously it would be because the doctor's office sent the claim to the old insurance company. I am thinking that maybe tomorrow I will call the urgent care office and give them our new health insurance info and see if they can resubmit the claim to the correct insurance company. Can I even do this? I feel so stupid that I did this in the first place. I really don't want to have to pay the $108 if our insurance will pay it for us. One other thought: I paid a $20 co-pay for this visit but with the new insurance the co-pay should only have been $10. Will I get that $10 back?

TIA!

Don't feel stupid. There are a lot of people who get caught up when they are changing insurance. Just call the urgent care office tomorrow and provide them with the right insurance information. TBH, I'm kind of surprised that they did not verify coverage when you were seen. It is done over the internet very easily.

And you should get your copay refunded. But probably not until the urgent care place has been reimbursed by your insurance and your account shows a positive balance of $10.

 

[Leajess99]

In October I took my son to a local urgent care office because he was complaining of an ear ache (which he did have a double ear infection). Anyway, I accidentally gave my old insurance card (we switched from my health insurance plan to my DH's health insurance plan on September 1, 2011). This week I received a bill for $108 because the claim was denied, which obviously it would be because the doctor's office sent the claim to the old insurance company. I am thinking that maybe tomorrow I will call the urgent care office and give them our new health insurance info and see if they can resubmit the claim to the correct insurance company. Can I even do this? I feel so stupid that I did this in the first place. I really don't want to have to pay the $108 if our insurance will pay it for us. One other thought: I paid a $20 co-pay for this visit but with the new insurance the co-pay should only have been $10. Will I get that $10 back?

TIA!

Yes, you can do that. They shoud be helpful as they want to get paid. Pnce they get paid from the insurance than they should refund the extra you paid.

 

[clh2]

Absolutely ask them to resubmit with the correct info. The billing departments do this all the time.

In a related note: DD just got her wisdom teeth out. Oral surgeon's office "just had" to have our medical insurance info in addition to our dental insurance info.

So - just last week - we got a "claim denied" from medical (DUH), and they called our house on Tuesday, and got DH who politely suggested that they submit to our dental insurance. DH also referenced our "quote" from the consult - which clearly referenced the dental insurance. DH also suggested we aren't paying anything more than what we paid from the estimate, which was paid at the time of service.

Did I mention - they "HAD" to have the medical insuarance number.

Luckily they got DH - I would have probably been screaming at the person. (OK - I realize that doesn't accomplish anything...but still.)

 

[Lintasare]

Absolutely you can do this. I work medical insurance claims and we get claims all the time where the submitted the information wrong and the provider submitted a corrected claim to us.

Just call and update your information with them.

As for the copay I would wait until your insurance pays the office and the claim summary they will get will show the correct copay amount. So they should automatically send a refund.

 

[pamjb]

Absolutely ask them to resubmit with the correct info. The billing departments do this all the time.

In a related note: DD just got her wisdom teeth out. Oral surgeon's office "just had" to have our medical insurance info in addition to our dental insurance info.

So - just last week - we got a "claim denied" from medical (DUH), and they called our house on Tuesday, and got DH who politely suggested that they submit to our dental insurance. DH also referenced our "quote" from the consult - which clearly referenced the dental insurance. DH also suggested we aren't paying anything more than what we paid from the estimate, which was paid at the time of service.

Did I mention - they "HAD" to have the medical insuarance number.

Luckily they got DH - I would have probably been screaming at the person. (OK - I realize that doesn't accomplish anything...but still.)

Just an FYI, sometimes wisdom teeth extraction can be covered under medical or dental. I work for a major health insurance carrier, and when my oldest had his wisdom teeth pulled, some of the claim was paid under medical and some under dental. It all depends how the contact is written.
The oral surgeon's office was just covering all the bases.

 

[angierae]

Absolutely ask them to resubmit with the correct info. The billing departments do this all the time.

In a related note: DD just got her wisdom teeth out. Oral surgeon's office "just had" to have our medical insurance info in addition to our dental insurance info.

So - just last week - we got a "claim denied" from medical (DUH), and they called our house on Tuesday, and got DH who politely suggested that they submit to our dental insurance. DH also referenced our "quote" from the consult - which clearly referenced the dental insurance. DH also suggested we aren't paying anything more than what we paid from the estimate, which was paid at the time of service.

Did I mention - they "HAD" to have the medical insuarance number.

Luckily they got DH - I would have probably been screaming at the person. (OK - I realize that doesn't accomplish anything...but still.)

I just went through this - my dental insurance (Humana) insists that they bill the medical insurance first - of course it gets denied, and then the dentist has to send the proof that Blue Cross denied it, and then Humana will pay it. It's a huge pain in the keester.

 

[jmartinez1895]

My daughter just had a tooth taken out that was under her sinus. Our dental paid the surgeon and office visits and our heath paid the out patient center where she had the surgery and the anesthesia . OH-well as long as it got paid I'm not worried about it.

My ex husband changes insurance all the time and I often give the provider the wrong info ( bot knwing at the time there has been a change). I give them a call and they refile. No trouble at all.

 

[Leajess99]

Absolutely ask them to resubmit with the correct info. The billing departments do this all the time.

In a related note: DD just got her wisdom teeth out. Oral surgeon's office "just had" to have our medical insurance info in addition to our dental insurance info.

So - just last week - we got a "claim denied" from medical (DUH), and they called our house on Tuesday, and got DH who politely suggested that they submit to our dental insurance. DH also referenced our "quote" from the consult - which clearly referenced the dental insurance. DH also suggested we aren't paying anything more than what we paid from the estimate, which was paid at the time of service.

Did I mention - they "HAD" to have the medical insuarance number.

Luckily they got DH - I would have probably been screaming at the person. (OK - I realize that doesn't accomplish anything...but still.)

This is done because medical insurance is more willing to pay for things like anesthia if the teeth are not yet erupted. Our insurance actually paid under the medical claim and not the dental which saved us money. My son only required novacaine for the removal of his 4 non erupted wisdom teeth.

 

[Jey12]

I just went through this - my dental insurance (Humana) insists that they bill the medical insurance first - of course it gets denied, and then the dentist has to send the proof that Blue Cross denied it, and then Humana will pay it. It's a huge pain in the keester.

That's just part of the insurance game. Medical is less likely to pick at charges so that's who gets billed first. Often times your dental insurance will want to know it's been denied before they pay out. It's just all a silly game they play with one another and waste the Dr's time doing it.

For the OP it shouldn't be a problem. You aren't the only one that's done this, you're probably not the only one that did the same thing that day. It happens often and the staff at Urgent care shouldn't even blink when you call them. All they want is to get paid and your current insurance shouldn't cause an issue with paying it, as long as you paid your copay if you have one for urgent care. I wouldn't even worry, it really should all be easily taken care of, it happens. All of those cards look alike!

 

[indimom]

We've been in both situations outlined in this thread and all of the advice has been spot on.

Disnyluvr:
We changed insurance companies twice (so three companies) in one year when DD was a baby (so lots of well visits, sick calls) and it was a freaking nightmare. Even when the office had the correct information, they would bill the wrong company. I about went nuts trying to get it all straightened out...and it took months, but I was reimbursed for overpayments in the end.

clh2:
DD just had a wisdom tooth and odontoma removed this year. The oral surgeon's office also billed medical first, then dental. The receptionist explained this process in detail for me at her first appointment because most of their patients are unaware that medical may cover some of the bill. So you and I are not alone in that regard.

 

[mjkacmom]

This is done because medical insurance is more willing to pay for things like anesthia if the teeth are not yet erupted. Our insurance actually paid under the medical claim and not the dental which saved us money. My son only required novacaine for the removal of his 4 non erupted wisdom teeth.

Same here. I thought it was common practice to go through medical first (our surgeon told us medical would most likely cover it, and they did), and then dental (which usually doesn't pay as much). I don't think they're playing any games.

 

[Tink-aholic]

To OP: just be prepared that it may be outside of timely filing limits. Filing limits vary widely between insurance companies; some are as long as six months and some, like BCBS in most states is only 60 days. If that is the case, the insurance won't accept any claims over the limit and the bill is yours to pay.

Good luck.

 

[Tinknalli]

To OP: just be prepared that it may be outside of timely filing limits. Filing limits vary widely between insurance companies; some are as long as six months and some, like BCBS in most states is only 60 days. If that is the case, the insurance won't accept any claims over the limit and the bill is yours to pay.

Good luck.

I was going to say the same thing, although it can vary. BCBS VT is 6 months but the hospital I work for has it in their BCBS contract that we have a year. Others such as Cigna it is 90 days.

 

[disny_luvr]

OP here,

I called the Urgent Care center today and she said that it wasn't a problem to resubmit the claim. She told me that this happens often. Thanks for the help. I'm glad I called.

 

[bumbershoot]

Glad it's being taken care of!


DS had an ER visit and ambulance ride not even a week after DH had started a new job. So the old insurance wasn't valid anymore, but the new insurance hadn't sent out cards, etc yet. Confusing matters, it was going to be with the same insurance company, same sort of high deductible plan. All we could give them was his SSN and name, etc, with the explanation that it was going to get confusing.

Every single bill first went through the old insurance account and was denied. Then, as the denials and the bills came in, I had to contact each billing place to give them the "new" information (same SSN, same name, same insurance company, new company which we gave them up front but I guess they ignored?, nothing really was new that we gave them, everything had been given before), and then it finally got taken care of.

At least you KNOW who is billing you, and don't have to wait for umpteen providers and hospitals and ambulance companies and whatnot to stake their claims....