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?

163 Upvotes
  • permalink
  • reddit

94% Upvoted

90 comments sorted by

View all comments

18

u/milkpickles9008 8d ago

If the anesthesiologist is an in network contracting provider with your insurance and they missed the timely filing period to submit the claim then do not pay that bill. It sucks, but just keep talking to your insurance company. Have them escalate it if the rep has any power to do that.

7

u/LividLife5541 8d ago

lmao it sucks being charged thousands of dollars months after the fact because doctors can't get their shit together. They literally pay people to do this for them. This isn't some arcane financial number that takes a KPMG audit to provide. It's a medical service they do on a weekly if not daily basis and for which the billable costs have already been negotiated.