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?
2
u/N2wind 8d ago
Timely filing is a provider issue. They have to eat it. File a complaint with CMS since this is a Medicare HMO. Medicare audits are about the worst thing for a provider as far as billing goes. I have carriers that only allow 90 days for timely filing but some go to 2 years. I have done anethesia and pain billing for over 25 years and you would not belive the providers that think they can balance bill patients due to their previous billing company errors. Just this week I wrote off 3 years of office visits (around 15) for 1 patient because the previous billing company kept billing the wrong insurance and now it is past timely.