clinic would not put my insurance information in their system

[otezla]

What is the name of your state (only U.S. law)? Florida

Hi, I am a medical student doing my last year of rotations before graduation. About the middle of February of this year I visited the ER of a clinic to have a CT scan done. An ENT doctor suspected cancer of my lymph node the day before, and I did not know where to go for the CT scan except the place I'm doing my rotation at. I remembered giving this clinic my insurance information then (I have student health insurance administered by Aetna).

I first received a bill for over $5000 from the clinic, and I contacted them to give my insurance information because I saw that they did not keep it on file. Couple months ago, i received a letter from collection (I guess it is a company associated with the clinic) for about $1000 of the balance. I called the billing department again to give my insurance info and was told not to worry about the letter for the time being. A couple days ago, I called again, was told they still did not have my insurance information on file, that my account was already at collection, and that I needed to call collection to give them my insurance info. At this point, collection told me the claim was already over 90 days old and would likely not be accepted by my insurance, and that the whole balance will be my sole responsibility.

I never dealt with collection agency before in my life but I felt like they just wanted me to pay and pay up fast. I also made the mistake of not documenting who I talked to before at the billing department because now the blame is on me for not giving them my insurance information in a timely manner. I know emergency room visit is expensive even with insurance but never expect to be caught in this situation. I am baffled as to what to do and hope for your advice. Many thanks in advance!

 

[Proserpina]

OP, you need to look at the EOB first of all, and find out exactly what happened and when - it does sound like there are a couple of possibilities to explain the snafu.

 

[ecmst12]

Is the facility where you went contracted with your insurance? If so, they can't bill you for the balance if they failed to submit the claim in a timely manner. Have you called your insurance company to see if they ever received the claim?

Incidentally, the doctor who ordered the scan should have been able to suggest places to go, and your insurance company could have told you about contracted facilities, rather than the emergency room, which would NOT be the proper place to go for this type of diagnosis. It's possible that if your insurance has received the claim, they denied it for non-emergency use of the ER. It's not the MOST likely possibility, but it's on the list.

 

[otezla]

Is the facility where you went contracted with your insurance? If so, they can't bill you for the balance if they failed to submit the claim in a timely manner. Have you called your insurance company to see if they ever received the claim?

Incidentally, the doctor who ordered the scan should have been able to suggest places to go, and your insurance company could have told you about contracted facilities, rather than the emergency room, which would NOT be the proper place to go for this type of diagnosis. It's possible that if your insurance has received the claim, they denied it for non-emergency use of the ER. It's not the MOST likely possibility, but it's on the list.

Thanks for your replies. They never billed my insurance company because they claimed I did not give them my insurance information within 90 days. I currently have no ways of proving that I did.

My insurance does cover for such visit at the facility, though I would expect my out of pocket responsibility to be high after the insurance, but not $5000.

 

[Zigner]

Thanks for your replies. They never billed my insurance company because they claimed I did not give them my insurance information within 90 days. I currently have no ways of proving that I did.

My insurance does cover for such visit at the facility, though I would expect my out of pocket responsibility to be high after the insurance, but not $5000.

It's not $5,000, it's about $1,000 (as you posted above.) For the type of plan you have, 20% co-insurance is certainly believable.

 

[otezla]

no it was never billed to my insurance. I checked my online account and also called them. when they send a balance to collection, they send it by parts- so it is $1000 now and another $4000 later.,

 

[Zigner]

no it was never billed to my insurance. I checked my online account and also called them. when they send a balance to collection, they send it by parts- so it is $1000 now and another $4000 later.,

Then I would suggest that you file that claim yourself.

 

[otezla]

Then I would suggest that you file that claim yourself.

I would, except that it passed 90 days which the insurance most likely won't accept.

I know whatever coinsurance is is my responsibility. I have no issues doing the legwork either but I didn't know what the issue was. The problem is that they never billed my insurance and blamed me for not giving them my insurance info in a timely manner, and I have no proofs that I did.

 

[Zigner]

I would, except that it passed 90 days which the insurance most likely won't accept.

So, the possibility that it MIGHT be rejected is making you not file the claim?

 

[Proserpina]

So, the possibility that it MIGHT be rejected is making you not file the claim?

Exactly.

OP needs to refile - otherwise it's guaranteed that OP is on the hook.