Miscoded procedure sent to collections.

[u/1962Michael]

Months ago, my wife had an ultrasound, ordered by her doctor, to investigate abdominal pain. The insurance denied coverage. She investigated and it turned out that the hospital had coded it wrong. In other words they were trying to charge for a procedure that wasn't approved, instead of the procedure that WAS approved.

She went round and round with the doctor's office and the hospital, about who needed to recode the procedure. She finally got it recoded, and then the hospital kept sending her the bill. But she never got another EOB from the insurance.

She spoke to the hospital and asked if they had resubmitted the corrected procedure to insurance. They said they can't bill the insurance without her permission. (WHAT? They won't do a procedure without having your insurance info and your permission to bill.) So she told them "you have my permission. Please bill my insurance using the corrected code."

She still hasn't gotten an EOB from insurance. Yesterday she got a letter from a collection agency on behalf of the hospital.

Any advice on how to handle this? Collection agency wants a response or payment.

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[u/Sudden_Upstairs3413]

Tell them you need to see the EOB denial from the second submission before considering any kind of payment.

[u/1962Michael → u/Sudden_Upstairs3413]

Thanks. Their letter included a response form. One space is "I do not believe I owe this bill because ____". We can start with that.

[u/wistah978 → u/1962Michael]

"Because the hospital has agreed that the bill is not owed. They have acknowledged that they billed this account incorrectly. They have submitted a corrected bill to my insurance company and it is currently pending review. Please confirm that you have deleted this inaccurate account from my credit report and have returned this account to Joe Schmoe Hospital. You may contact (billing person you dealt with) at (#) to confirm."

Also ask the billing people to retract the bill from collections. If you have something in writing from the billing people saying they are correcting the bill, send that to the collections people (with medical details blacked out) to support that the bill is invalid.

[u/SupermarketSad7504]

Send them written letter stating you are refusing payment until the hospital sends the bill to your insurance. They officially have not filed. Do not say resubmit. Just state they haven't yet filed the claim for consideration. The collection team will turn it back to the hospital billing. File a complaint with the patient advocacy team at the hospital as well. They've turned me to collection without filing a claim for payment with insurance for code xxxxx

[u/LizzieMac123]

How long ago did the hospital say they resubmitted the corrected claim? If it's been at least a week or two, you should be able to see if in your insurance portal as a pending claim.

You could also ask the hospital to call off their collections team since this was a case you needed THEM to fix.

Collections agency's job is to be pushy and get a payment- you can always say that you have a pending claim wth insurance for this and you'll be happy to pay what is owed once your insurance finalizes that pending claim.

[u/1962Michael → u/LizzieMac123]

Thanks. It's been several weeks. When the hospital called, they SAID they would turn over to collections unless they got a payment then. She asked them to re-bill insurance, but I have no idea if the people calling for payments are the same people who bill insurance. I'm afraid it's a "not my job" problem.

We haven't seen a new EOB yet. I'll wait a couple weeks until it's closer to the collection agency's response deadline, and then use words to that effect on the response form.

[u/LizzieMac123 → u/1962Michael]

I mean, I wouldn't just let this keep sitting- you're going to have to start being a pain in the ass if I'm being honest. Call insurance and see if they ever recieved a corrected claim, if they say no, ask them to 3 way call the provider's billing department with you to tell them they need to correct the claim and submit it.

Sitting back and waiting is how this ended up in collections.

[u/AmazingBag3301 → u/1962Michael]

I would call your insurance. Tell them what's happening. Refer them to their original denial and any information you have on the corrected code. See if your insurance will call the billing dept of the hospital and get them straight. Insurance with good customer service should be willing to do this.

[u/HelpfulMaybeMama]

They have to code it for the procedure they performed, even if that wasn't the one that was approved.