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/EamusAndy 8d ago

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

43

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/nestchick 8d ago

When I was a claims examiner I discovered we had been overpaying dialysis claims, but we only looked back 2 years when seeking reimbursement from the providers. I found $177K worth of overpayments. Did we collect all that? No. The results of my review were sent to provider relations to negotiate settlements. No way did we get the full amount back. So I am not sure where you got “years” regarding retroactive denials. Kindly show your math. ( And yes I know two years is “years “.)

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u/Whole_Bed_5413 6d ago

What are you even talking about with your anecdotal evidence of maybe one company (if you are veing accurate). And by the way, the people nsyrance company obviously paid these claims you speak of and “overpaid” is relative considering that most insurance companies pay a fraction of market rate and an even smaller fraction of charges.