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/LizzieMac123 Moderator 2d ago

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.

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u/1962Michael 2d ago

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.

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u/AmazingBag3301 1d ago

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.