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/Whole_Bed_5413 8d ago

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.

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u/TheGreatAlibaba 8d ago

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.

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u/Puzzleheaded_Serve37 7d ago

Not all providers have 12months. A lot of newer provider contracts I’m seeing are giving 60/90/120 days to submit. Unless state law requires longer.

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u/TheGreatAlibaba 7d ago

Federal law requires longer for Medicare. Non-Medicare plans are certainly different.

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u/Puzzleheaded_Serve37 7d ago

I’m assuming that this is a Medicare secondary not MedAdvantage hence the short timely filing period.