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/JKTX30 → u/Long-Raccoon2131]

If it is an emergency, they cannot trick you with hidden "patient responsibility" clauses in the fine print anymore, thanks to the No Surprises Act, whether it is in or out of network. (Of course, you are still responsible for any deductibles and copays that maybe applicable, but emergency care is covered at the in-network benefit level.)

[u/Long-Raccoon2131 → u/JKTX30]

Emergency means you could not be of sound mind to make a decision therefore whatever treatment is protected by that ACT. If you go on your own free will even if you called for the ambulance you on your own volition enacted the request and it was up to you to understand your plan. Also not all insurance is covered under that ACT either only Medicare specifically and if a states medicaid chooses to. Most marketplace ACA plains abide by it. Yet employer insurance or private bought it does not protect it. EMERGENCY doesnt mean you went to the ER for anything it means you went and had no knowledge of it and you were sent without you asking. This is mostly about air transportation or major accidents where you are unresponsive and they send you wherever

[u/JKTX30 → u/Long-Raccoon2131]

This is incorrect. The standard of an emergency is the reasonable person standard that someone would reasonably believe they are in danger of death or serious impairment of some kind if they do not seek immediate treatment. And the act covers going to any emergency room in that case, whether by car or ambulance or whatever. And the act also covers most all common types of health insurance plans. You can read all the details here and the no surprises act is in fact pretty broad in its protections against surprise billing in emergency (and even some non-emergency) situations. https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/publications/avoid-surprise-healthcare-expenses