r/HealthInsurance • u/JulesSherlock • 8d ago
Medicare/Medicaid Anesthesiologist is billing $3700 even though insurance is telling them to stop.
My husband went to the emergency room due to food blocking esophagus. He had to have a gastroenterologist, push it on down. The anesthesiologist billed his insurance who refused it based on it being filed too late. Procedure was 3/8 and they billed 7/1. Then they billed him $3700, which is when he noticed the issue. Said insurance paid $0 and if he didn’t pay by 9/15 it would go to collections. He called his insurance (United Healthcare - Medicare) and they said they would call them the next day and have them refile it. He watched for it online and saw that it had been re-filed on 8/1 so he thought it was ok. Well, insurance denied it again. It says denied due to filing too late and do not bill member. Same as last time. So he expects to get a bill in the mail any day now.
I feel like we’re going in circles. How do we get off this ride if we do get the bill again?
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u/wistah978 8d ago
Assuming they were in network, timely filing is the responsibility of the provider. You should have an EOB showing your responsibility is $0. The EOB will also likely say something to the effect of they cannot bill you. Ask the office for a fax or email and send them the EOB. I would say that because they are threatening collections so soon that you are requesting an email confirmation within 3 business days that you are not responsible for the bill so that you have time to notify your state's insurance commissioner. (Who may not be able to do much but should get their attention.).