Balance Billing?

[RobertChartier]

What is the name of your state? Massachusetts

I live in MA. I worked for a company that is based out of NY State, and through them, had Excellus Blue Cross and Blue Shield.

At the tail end of Calendar year 2018 My wife went in for physical therapy. The hospital is in Network. We had already reach our out of pocket maximum for the year. In July of 2019, we received a bill from the hospital. All of the Benefit statements from Excellus show that there is no patient responsible payment.

Wife went in for Occupational therapy (hand injury) in January of 2019. By the time these bills were submitted to Excellus, we had made out deductible. However, the bills show that we owe nearly TRIPLE what Excellus says is the patient responsible payment.

It appears to me that this is a case of balance billing. What are my recourse here folks?

 

[cbg]

When you called the billing office of the physical therapist and asked for an explanation, what did they say?

 

[RobertChartier]

Their phone service is horrible. It took me nearly 2 weeks to get a customer service rep on the line. I just got off the phone with them. Since the bill is for my wife, the refused to speak to me without her permission. Considering that I have that power for all of her medical billing and medical care, this sounds decidedly fishy to me.

Regardless, I have forwarded them copies of all of the Explanation of Benefit forms from my medical insurance, for each of the 2 accounts. These forms clearly state what was charged, what the Insurance allows and paid out, and what the patient responsibility is.

As soon as my wife gets home, I'll have her call them and give them the permission to discuss these bills with me. They assure me that once this is done, they will "review the account".

 

[Zigner]

Since the bill is for my wife, the refused to speak to me without her permission. Considering that I have that power for all of her medical billing and medical care, this sounds decidedly fishy to me.

There is nothing "fishy" about their compliance with federal law.

 

[ajkroy]

Contact your insurance company. They will straighten it out.