Provider refuses to file claim with my Insurance Company

What is the name of your state?
Ohio

One year ago my daughter had tests done at the children’s hospital, in which the hospital was able to correctly file the claim with the insurance (an HMO) and receive payment for its portion. However the imaging provider for these tests, which is a different entity than the hospital, never did file a claim with the HMO. Repeated calls and letters with the proper insurance information to the imaging provider did nothing, they claimed that it was denied by insurance. I contacted my insurance and said that they had no record of the claim and told me to tell the imaging provider to file the claim properly. So the circle continued..

Finally I found a form (found only by extensive searching of the HMO website) in which I could file the claim myself and within a few weeks I received the Explanation of Benefits showing the contracted amount being paid. However at this time the imaging provider sends the bill to collections and it shows up on my credit report.

-Is a health care provider required to file a claim with an Insurance Company?
-Does an Insurance Company have to send an Explanation of Benefits explaining the payment or why it was denied for every claim received by a provider?

[Beth3]

Is a health care provider required to file a claim with an Insurance Company? Actually, no, they're not. They do it because it's the best way for them to get paid promptly and as a courtesy to the patient. They're not obligated to accept payment from a third party however, nor are they obligated to file an insurance claim for the patient.

Does an Insurance Company have to send an Explanation of Benefits explaining the payment or why it was denied for every claim received by a provider? Yes, if that's what the terms of the contract between the insured and the insurer calls for.

Thanks for the feedback, Beth3.

Now that I think about this, I can see a reason why the provider would not want to file the claim. The contracted rates that the provider receives from my HMO can be 50-85% less than the billed rate. So the provider has less interest in filing the claim for patients with this insurance.

The mistake I made was thinking that the provider actually was trying to file the claim.