Medical bill that was submitted incorrectly

[Barcenas814]

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


Okay, so i need some help on this.....Over a year ago i had an outpatient procedure done and bout 3-4 months later i received a bill in the mail from a pathology office for almost $200.00. I called my Insurance company immediately and asked the question everyone asked..."why am i getting a bill for this amount?" My insurance company told me that the pathology office had billed the claim incorrectly and was notified to resubmit the claim so that it can be processed and paid for (service was covered per my ins company) they also informed me that it has been over a year, and if the office decided to re-do the paperwork per my insurance company..stated it would denied because the length of time they took to resubmit the claim.


So, now its been over a year and the bill was sent to collections I tried to explain the them about the claim and they told me i needed to send them proof. I faxed over my EOB (which also shows the comments how the claim was wrong, etc etc etc) and they still were no help to me stating that I needed to pay the bill.

I cut out the middle man and called the pathology office and spoke to their billing department. The lady i spoke with told me that they would have to re-do everything & submit the claim. Now, I told the lady exactly what my ins company told me (how they would deny the claim because its been over a year) and she said if that was the case... then the pathology office would just have to eat the bill for the simple fact that they didnt resubmit correctly within that time frame.


Also, this bill is showing on my credit report, I think it should not be on my credit report at all & it should be deleted immediately. When i spoke with the lady in the billing dept for that office.. she told me that the collection agency would not take it off... That it was my responsibility to call them and dispute this matter.

Regardless, it was a claim that was billed BY THEM incorrectly and should have NEVER been sent to collections if they would have just resubmitted within that year.

How do I go about removing this from my credit report? From what she is telling me...its going to stay on there showing: PAID/ACCOUNT CLOSED

I think it shouldnt be on there PERIOD!!!

Please help me


Thankyou

[ecmst12]

You need to dispute the bill with the credit reporting agencies. You need to wait until AFTER the bill is resolved before you can do this.

[JETX]

Originally Posted by Barcenas814

Okay, so i need some help on this.....Over a year ago i had an outpatient procedure done and bout 3-4 months later i received a bill in the mail from a pathology office for almost $200.00. I called my Insurance company immediately and asked the question everyone asked..."why am i getting a bill for this amount?" My insurance company told me that the pathology office had billed the claim incorrectly and was notified to resubmit the claim so that it can be processed and paid for (service was covered per my ins company) they also informed me that it has been over a year[, and if the office decided to re-do the paperwork per my insurance company..stated it would denied because the length of time they took to resubmit the claim.

Hmmmm.... need to get your FACTS straight....
Your post says that you received the bill from the pathology department "3-4 month" after the service was provided and you (promptly??) contacted the insurance company who told you about the incorrect billing. You then JUMP forward to "that it had been over a year".

What did YOU do in the ensuing 9 months to resolve YOUR billing problem??

People do NOT understand their responsibility in medical payments and simply assume that it is the insurance company's obligation to pay. That is NOT the case. YOU hire the insurance company to provide medical payments under YOUR policy. The fact that the hospital or doctor 'direct bills' to the insurance company does not waive YOUR obligation to pay the bill. If the insurance company refuses, or even simply screws up, it is still YOUR obligation to pay. You can then pursue your claim against YOUR insurance company but it is NOT their OBLIGATION to pay your bills for you.

So, now its been over a year and the bill was sent to collections I tried to explain the them about the claim and they told me i needed to send them proof. I faxed over my EOB (which also shows the comments how the claim was wrong, etc etc etc) and they still were no help to me stating that I needed to pay the bill.

They are correct. The bill obligation is YOURS and YOURS alone. Once you pay YOUR bill, you can certainly pursue your claim against the insurance company, but if the doctor failed to provide the right 'codes', the insurance company has no obligation to pay as it was not their 'fault'. Pursue your claim with the doctor/billing company.

I cut out the middle man and called the pathology office and spoke to their billing department. The lady i spoke with told me that they would have to re-do everything & submit the claim. Now, I told the lady exactly what my ins company told me (how they would deny the claim because its been over a year) and she said if that was the case... then the pathology office would just have to eat the bill for the simple fact that they didnt resubmit correctly within that time frame.

Yep. You got it. The doctors office is liable.... however, since they have several years (set by your state SOL) to pursue collection, they are also 'immune' to your claim.

The fault here really falls back on YOUR since YOU failed to pursue the matter in a timely way BEFORE the insurance 'protection' expired (one year apparently, you need to read your policy).

Also, this bill is showing on my credit report, I think it should not be on my credit report at all & it should be deleted immediately.

You're NOT correct. YOU received the service, correct?? You are liable for the bill.

When i spoke with the lady in the billing dept for that office.. she told me that the collection agency would not take it off... That it was my responsibility to call them and dispute this matter.

Correct.... but based on your post, the bill, and credit report, are accurate and likely will NOT be removed.

Regardless, it was a claim that was billed BY THEM incorrectly and should have NEVER been sent to collections if they would have just resubmitted within that year.

And when EXACTLY did you contact them about the problem WITHIN THAT YEAR??

How do I go about removing this from my credit report? From what she is telling me...its going to stay on there showing: PAID/ACCOUNT CLOSED

You can certainly file a dispute or even place a 'consumer note' on the account providing an explanation. However, based on your post, I see no LEGAL issue here.

[Barcenas814]

Im just gonna dispute this with the credit reporting agencies. I did follow up within that year and was told that it would be submitted properly. however it was not taken care of, i was already informed by my ins company that i'm not responsible for the bill, the pathology office (that submitted the claim to my insurance company) also stated that they were in the wrong as well. Their billing dept said they were gonna re-do paperwork ONLY to see if my ins would accept it again (the correct way) and if that didnt work they would just eat the bill because they failed to resubmit the claim.

yes I had services (that were covered 100%) but being the fact it was billed wrong of course it was rejected.

My man concern is that this claim was sent to collections & that it is on my credit report when it should not have gotten that far. I just hope that it can be removed.

[ecmst12]

IF the lab participates with your insurance company, then yes your insurance company can require them to write off the bill if they did not follow the guidelines for submission.