Do I owe this?

[piemaker]

What is the name of your state?What is the name of your state? Calif.

I was recently sent to collections for an outstanding balance from a radiology group which is billing me for a service that my private health insurance company says: "This amount has been determined as not allowed due to clinical review of the appropriateness or necessity of this service. Because this is a participating provider, the member is not responsible for this amount". The collection company insists that I must pay for the service or they will report this to the credit company. I called the insurance company and they said they will look into it. In the mean while, the collection co. is making a credit report.
Any input would be appreciated!

[Mr.Knight]

Was the hospital in network or out of network?
Insurance companies set state how much they pay on certain items.
If it was in network then and you paided your Co-pay then you shouldn't owe the money.
if it was out of Network then you owe the money.
If what you put is true then you shouldn't owe the money. it appears that they over charged the insurance.
i would send a copy to the collection company along with a dispute letter, asking for a VOD (verication of Debt).
By law they have to stop collection actions till they get the VOD.
Now all this has to be done within 30 days of the date of placement with the collection agency.
When you send the letter and the copy of the insurance form you got back. make sure that you Fax it and send it CERTIFIED MAIL RETURN RECIEPT REQUESTED, to ensure someone signs for it.

[stevek3]

Originally Posted by piemaker

What is the name of your state?What is the name of your state? Calif.

I was recently sent to collections for an outstanding balance from a radiology group which is billing me for a service that my private health insurance company says: "This amount has been determined as not allowed due to clinical review of the appropriateness or necessity of this service. Because this is a participating provider, the member is not responsible for this amount". The collection company insists that I must pay for the service or they will report this to the credit company. I called the insurance company and they said they will look into it. In the mean while, the collection co. is making a credit report.
Any input would be appreciated!

The biggest mistake you can make is by doing things over the phone. Phone communications don't preserve rights. If you have a beef with the claims department at the insurance company, do it in writing. Certified mail is prudent.

This could be something as simple as a coding problem. I'm assuming your doctor ordered the x-rays for which you received a separate bill. Coordinate your efforts with your doctor's office.