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/CrabConsistent9777 8d ago

Something is off here. Did the provider say there was a denial at all? The best thing would be to get on a three-way call with your insurance and provider. An untimely denial for something performed less than a year ago is unusual, but it depends on the plan.

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u/JulesSherlock 8d ago

Their bill just said that Insurance paid zero and we owed the full amount.

So then we looked up the claim on the Insurance site and it said it was not filed in time (timely manner) and do not bill member. And they were paying $0. His responsibility was $0.

Didn’t seem like much time to me, I mean the procedure was March 8 and they billed insurance July 1. Insurance denied payment 7/22. And we received the first bill shortly after that. The anesthesiologist refilled with the insurance company on 8/1 and insurance just denied it again.

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u/CrabConsistent9777 8d ago

But did you call anybody? Just a suggestion, but patient's typically get to see their EOB before the provider, so maybe the provider hasn't seen the second one. They can compare the claim number. There are too many variables that could have gone wrong for anyone here to narrow down. You should get the insurance on the phone and have them call the provider's billing office while you are on the line. Someone from either side could just be reading off their computer screen without actually looking into it any deeper. Let them fight it out in front of you, otherwise you might be in this endless cycle of them pointing a finger at each other.