r/HealthInsurance • u/1962Michael • 2d ago

Plan Benefits Miscoded procedure sent to collections.

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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