Medical Balance Billed Illegally?

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MJT7665
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Medical Balance Billed Illegally?

Post by MJT7665 » Sat Oct 13, 2018 12:14 pm

I had an account from a medical group fall into collection status so I paid it to prevent it showing up on my CR. The total amount was near $1600.

I went to investigate my claims and it looks like the billed me the original amount (not contracted member rate) minus what the insurance paid. This would make sense if there were not in the network. But I confirmed with Aetna that they are indeed in my network and must honor the contracted rate. So my $1600 should have been $38.

Needless to say I’m a little upset. What they did was technically fraud. Paying this caused me stress and a few months of concisely burden. Can I reasonably expect to get more than my money back?

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cheese_breath
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Re: Medical Balance Billed Illegally?

Post by cheese_breath » Sat Oct 13, 2018 12:27 pm

Have you talked to them, see if possibly they made an error?
The surest way to know the future is when it becomes the past.

MJT7665
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Re: Medical Balance Billed Illegally?

Post by MJT7665 » Sat Oct 13, 2018 12:30 pm

I found this out on Thursday so I called them and Friday. They said both times I have to call back on Monday. It’s likely a mistake but paying this money out caused hardship and getting a full refund back doesn’t seem enough for me.

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cheese_breath
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Re: Medical Balance Billed Illegally?

Post by cheese_breath » Sat Oct 13, 2018 12:33 pm

I'd suggest from now on when you get your claims reports, EOBs or whatever your insurer calls them that you check them over right away rather than waiting for the collection agency to tell you. There's a reason they send you those reports.
The surest way to know the future is when it becomes the past.

MJT7665
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Re: Medical Balance Billed Illegally?

Post by MJT7665 » Sat Oct 13, 2018 12:38 pm

I wasn’t aware of balance billing until recently but yes I am going to scour every single claim.

It went to collections because the rest of bill was littered with errors and I was going back and forth with the insurance company and healthcare provider. There were coding issues along with a bill for a two night visit when it was actually one (I have discharge papers). There were other ones but the bill as a whole has been a nightmare. Then for the doctor group to send it to collections after a month was even worse.

But yes, lesson learned. I just want my money back and to be done with this.

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cheese_breath
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Re: Medical Balance Billed Illegally?

Post by cheese_breath » Sat Oct 13, 2018 12:48 pm

MJT7665 wrote:
Sat Oct 13, 2018 12:38 pm
But yes, lesson learned. I just want my money back and to be done with this.
That's the right attitude. Get your money back and move on. I can't tell you how many problems I've had with Blue Cross. But if I let them fester in my mind forever I'd go crazy.
The surest way to know the future is when it becomes the past.

toofache32
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Re: Medical Balance Billed Illegally?

Post by toofache32 » Sat Oct 13, 2018 11:23 pm

You need to find out from the doctor if they were in-network at the time of services. Not from the insurance. I have been through this with multiple insurance companies as a doctor. I submit my letter to the insurance company that I am will no longer be in-network with their insurance. My longest record was one company (actually Aetna) took 11 months (!!!) to reconcile this in their database. The patients were obviously frustrated. I have also seen the opposite. I was in-network with plans and the insurance websites showed me as out of network. On another note, a doctor in my practice left in 2006 and moved across the country. As late as 2015 he was still listed on 2 insurance websites as being in-network at our practice. They do this on purpose to avoid payment of claims when the "gotcha" is revealed. The insurance companies benefit from lack of transparency.

Someone will be along shortly to tell you how this is not a problem with Kaiser.

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FIREchief
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Re: Medical Balance Billed Illegally?

Post by FIREchief » Sat Oct 13, 2018 11:48 pm

MJT7665 wrote:
Sat Oct 13, 2018 12:14 pm
Can I reasonably expect to get more than my money back?
No.
I am not a lawyer, accountant or financial advisor. Any advice or suggestions that I may provide shall be considered for entertainment purposes only.

Yooper16
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Re: Medical Balance Billed Illegally?

Post by Yooper16 » Sun Oct 14, 2018 9:27 am

My SIL worked in billing at a largish regional hospital. We had this occur on a bill where the EOB said "not the patients responsibility" or something similar.

She told me that, depending on the insurance company and the billing system used by the provider, many of these write-offs must be manually entered and are often the cause of errors.

She said don't pay any bill unto you see the EOB.

staythecourse
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Re: Medical Balance Billed Illegally?

Post by staythecourse » Sun Oct 14, 2018 9:31 am

MJT7665 wrote:
Sat Oct 13, 2018 12:14 pm
I had an account from a medical group fall into collection status so I paid it to prevent it showing up on my CR. The total amount was near $1600.

I went to investigate my claims and it looks like the billed me the original amount (not contracted member rate) minus what the insurance paid. This would make sense if there were not in the network. But I confirmed with Aetna that they are indeed in my network and must honor the contracted rate. So my $1600 should have been $38.

Needless to say I’m a little upset. What they did was technically fraud. Paying this caused me stress and a few months of concisely burden. Can I reasonably expect to get more than my money back?
My answer would be yes. Call them up and make sure they were in network at time of billing. If answer is yes call them up and have them check on it. They HAVE to reimburse you as they have a contract with your insurance to accept the allowable amount only.

Also, check to see if your state outlaws balanced billing for commercial insurers.

Good luck.
"The stock market [fluctuation], therefore, is noise. A giant distraction from the business of investing.” | -Jack Bogle

MJT7665
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Re: Medical Balance Billed Illegally?

Post by MJT7665 » Sun Oct 14, 2018 9:45 am

I live in NY so sending a balance bill for services rendered in the emergency room is illegal regardless if the doctor is in network. The bill in question was indeed in the network which makes it a double whammy!

Also I took the advice the above poster and another bill I got Friday had $852.52 worth of expenses I was not covered for because the treatment didn’t match my gender. It was a cyst drainage.

MJT7665
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Re: Medical Balance Billed Illegally?

Post by MJT7665 » Sun Oct 14, 2018 9:48 am

Yooper16 wrote:
Sun Oct 14, 2018 9:27 am
My SIL worked in billing at a largish regional hospital. We had this occur on a bill where the EOB said "not the patients responsibility" or something similar.

She told me that, depending on the insurance company and the billing system used by the provider, many of these write-offs must be manually entered and are often the cause of errors.

She said don't pay any bill unto you see the EOB.
I had already paid it because the same medical group is based out of the hospital and I mistook it for the actual hospital bill. It went to collections and I paid it right away. I should be able to secure a refund.

staythecourse
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Re: Medical Balance Billed Illegally?

Post by staythecourse » Sun Oct 14, 2018 9:56 am

Yooper16 wrote:
Sun Oct 14, 2018 9:27 am

She said don't pay any bill unto you see the EOB.
I've mentioned this SEVERAL times and agree. Do NOT pay any medical bill until you see your EOB and make sure the numbers match.

Good luck.
"The stock market [fluctuation], therefore, is noise. A giant distraction from the business of investing.” | -Jack Bogle

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FrugalInvestor
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Re: Medical Balance Billed Illegally?

Post by FrugalInvestor » Sun Oct 14, 2018 10:01 am

Yooper16 wrote:
Sun Oct 14, 2018 9:27 am
She said don't pay any bill unto you see the EOB.
My wife was a benefits administrator in her working days and handles all of our medical billings. She always does the above for both her on ACA insurance and me on Medicare. She scours and matches up all billings and EOBs, asks questions about anything that doesn't look right and only when she's satisfied that everything is correct does she pay the bill. She doesn't unnecessarily delay and she may pay the bill in part if there's an outstanding question on only a portion of the bill. But if things don't match up on something or she can't get satisfactory answers she withholds that amount and continues to pursue it or give the provider time to figure things out. It's not uncommon for the provider to re-bill or adjust billings for her prior to her making the final payment. I'm sure that the motivation to resolve these issues would often be reduced if she didn't take this approach.
IGNORE the noise! | Our life is frittered away by detail... simplify, simplify. - Henry David Thoreau

MJT7665
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Re: Medical Balance Billed Illegally?

Post by MJT7665 » Sun Oct 14, 2018 10:28 am

I definitely learned my lesson for sure. I’m going to be more diligent with these matters going forward. It was hard this year as I was traveling more than I was home. Not an excuse but just giving insight.

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