Balance Billing from doctor, split bill, one in-network, one out-of-network ?

[nickw]

(New Jersey)

My daughter had some vaccinations by a doctor that is normally in-network (Oxford) back in Oct 2014. On our healthcare statements, for that day there are 2 separate claims for different vaccinations, one of these was processed as in-network whilst the other was out-of-network and has since bounced around to a debt collector.

After much telephoning to try and work out what went on, the doctor was in the process of changing provided IDs so somehow just this single claim was out-of-network. We have other claims from same practice (but a different doctor) before the claim in question.

The doctors billing is just as useless and the insurance in wanting to sort this out. And I am originally Australian so still navigating this crazy health system. I would think given that there are 2 claims, same doctor, same day for the same type of service that I must have some way to fight this ?

Thanks,
Nick

 

[Zigner]

Because you've waited so long, you may not have any ability to contest this. Furthermore, in order to avoid the credit concern, you could have paid it and sought reimbursement.

 

[nickw]

It is quite old now, I had made numerous calls to both Oxford and the doctors group (St. Barnabas Health) but it was complicated as the doctor's group changed names and Oxford was telling me all sorts of different things about the claim.

I had a similar thing with some chiropractic treatments, but the doctor there eventually sorted it all out. He said that he did have to appeal and fight them but ultimately that was between him and Oxford.

But in this case, isn't it just between the doctors group (St. Barnabas Health Group) and me now. So all I need to do is convince them that they were in the wrong since they used the incorrect provider ID, proved by 2 claims on the same day ?

 

[cbg]

You need to call the Provider Relations area of the insurance carrier. Not claims, not Member Services; Provider Relations. They are the ones who determine what is and is now owed by the insured when there is a question regarding in- or out-of-network.