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/EamusAndy]

It is not your husbands fault the provider didnt bill timely. Thats on them.

[u/Whole_Bed_5413 → u/EamusAndy]

Interesting that physicians get months to file claims, yet insurance companies get years to claw back a retroactive denial. Right. It’s the physician’s fault. And what does the insurance company have to lise when the physician files later? Nothing. They get to hang on to money that they owe, interest free.

[u/TheGreatAlibaba → u/Whole_Bed_5413]

Providers have 12 months (so there's something else going on here), which should be more than enough time. And that's the initial billing, so if things are wrong and they need to be corrected, the clock restarts to the day the billing was processed. At least is Medicare.

And I have no problem with that. Providers shouldn't be allowed to wait years to bill either party.

[u/LamentForIcarus → u/TheGreatAlibaba]

This isn't true for all carriers. I have one Medicaid MCO that wants a claim within 60 days from DOS, though most usually do 90 to 180 days. This is theoretically enough time except a lot of places are understaffed so it can get backed up. Also, in my experience corrected claims are just as often from DOS as processing.

[u/TheGreatAlibaba → u/LamentForIcarus]

You are absolutely correct that it's different for Medicaid and other types of insurance. But this specific situation is Medicare and the 12 months is a CMS guideline. So all Medicare plans have that as a minimum.

[u/JKTX30 → u/[deleted]]

Wouldn't this fall under no surprises because it was an emergency?

[u/JKTX30 → u/[deleted]]

Okay, so basically with this situation we never even get to the point where NSA would come into play. Because the bill itself is invalid so why should they make payments on it? Even if it was sent to collections, the collections wouldn't be valid either.