Anesthesiologist is billing $3700 even though insurance is telling them to stop.

[u/JulesSherlock]

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?

[u/Long-Raccoon2131]

First is the provider in network? If not they aren't obligated by a contract with the health plan to not bill. Also at the ER did you fill put forms one of which thet call patient responsibility form? That form ks a legal document stating you agree to pay anything not covered by insurance. Now is Medicare the only plan? Because if there is a primary policy and Medicare is secondary then primary deductible and out of pocket trump secondary billing

[u/cuspeedrxi → u/Long-Raccoon2131]

This is the correct answer. Disregard the one-liners about ignoring the bill. You need to determine if the physician is in-network and if you agreed to pay for charges not covered by insurance.

[u/Ridgewoodgal → u/cuspeedrxi]

This is odd since almost everyone else is saying if in-network that it is not the patient’s responsibility. Don’t we always sign a form like that but it isn’t for mistakes made by an in-network hospital.

[u/cuspeedrxi → u/Ridgewoodgal]

It’s two separate considerations. 1) Is the doctor in-network? If so, he’s bound by the contract he signed with the insurer. If he filed the claim outside of the required window, then you’re off the hook. It’s his error. Though you may need to remind him of that. Don’t just ignore the bill. Circle back and explain why you’re not liable for the bill. 2) Did you sign a patient responsibility form? If he’s out of network, then you have to pay whatever he charges. But, what else does this form say? Any surprises??

Too often people on these subs advise you to “screw ‘em” and leave it at that. Then, bills get turned over to collections and people have a bigger mess of their hands because they ignored the bill or didn’t follow up, etc.

[u/bethaliz6894 → u/cuspeedrxi]

#3 - Was the insurance card presented in a timely fashion? If they checked in and said we will give the card later and didn't, they can still be on the hook for the bill.