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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u/Sudden_Upstairs3413 2d ago

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

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u/1962Michael 2d ago

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

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u/wistah978 2d ago

"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.