• FreeAdvice has a new Terms of Service and Privacy Policy, effective May 25, 2018.
    By continuing to use this site, you are consenting to our Terms of Service and use of cookies.

Medical biller not providing requested info to insurance for claim.

Accident - Bankruptcy - Criminal Law / DUI - Business - Consumer - Employment - Family - Immigration - Real Estate - Tax - Traffic - Wills   Please click a topic or scroll down for more.

carofl93

Member
What is the name of your state? Florida

State is Florida. I was unsure whether to post this in insurance or debt collection.

In September of 2019 I was hospitalized. The doctors at my local hospital ordered me transferred to a larger, more specialized hospital. The new hospital was an hour away in a different county and city. Ground transportation via ambulance was necessary due to tachycardia.

I got the first ambulance bill the day I was released. I mistakenly put my husband’s social security number on their internet portal. When I realized my error, 2 days later, I returned to the portal and put my own social security number on the bill. Got the second bill in January. Bill had a letter in the lower portion stating that they had submitted the claim but received no response. I checked my claims on the portal and did not see the claim. I sent the ambulance biller my social security information a second time. I got the third bill yesterday. They claim again that they have gotten no response from my insurer (Tricare).

I contacted Tricare via the beneficiary chat option. I was told by the Tricare rep that 2 claims had been filed under my name. The rep said that the thing holding up the claim is a trip report which is used to process mileage. The rep said that they have requested the trip report twice with no response from the biller.

I called the biller and spoke with their rep. The billing rep said that they mailed the trip report twice, on 12/26/2019 and 5/27/2020. Their rep said that the next bill will probably be the final bill. She said that when I get that bill, I will need to call to set up a payment plan so it won’t go to collections. The rep told me that the payment plan just needed to be set up and that I “did not have to make payments.” The rep claimed that “Tricare is always backed up.” I told the rep that they need to send the trip report and to call Tricare (I gave them the number that was given to me.)

I contacted Tricare through the secure messaging on the beneficiary portal. I explained what was happening and requested a records search for the 2 trip reports I was told had been sent. The Tricare rep performed a search for the trip reports. She said that there was nothing received, but that Tricare had sent 2 more requests for the trip report on 12/26/2019 and 5/27/2020. This means that Tricare has requested the trip report 4 times total.

I wrote a letter to the biller which will be mailed tomorrow. I informed them of the conversations I have had with 2 Tricare reps and their rep. I told them about the misinformation I was given by their representative. I also gave them the claim number and the direct fax number for the records department.

My fear is that this bill will be turned over to collections. I am thinking that their request for a payment plan is a way for them to get their money without Tricare getting the pricing reduced. My catastrophic cap was met. All of the other providers were able to submit the claims and be paid with no delay or issues.

Questions:
If this bill does go to collections without the biller submitting the requested information, is it legal?
Is their payment plan idea what I think it is?
Thank you so much.
 


doucar

Junior Member
Have you submitted the bill to Tricare yourself? Many providers take the position that submitting a bill to the insurance company is doen as a courtesy not an obligation.
 

carofl93

Member
I asked the Tricare representative if there was anything I could do to help the situation. They said the only thing hanging up the claims process is the trip report that has now been requested 4 times.
I gave the biller the phone number for claims.
I may contact the ambulance company directly to see if they can send it directly.
 

adjusterjack

Senior Member
If this bill does go to collections without the biller submitting the requested information, is it legal?
Yes.

Is their payment plan idea what I think it is?
A scam? No, I don't think so. But I certainly wouldn't believe that you can set up a payment plan and not pay it.

Here's an option. Get a copy of the bill and the trip report from the provider. Pay it yourself and then get reimbursed by TriCare.

I know. Why should you have to when it's not your mistake? Because self-preservation is nobody's business but your own. This SNAFU could go on for months and if it doesn't get paid it's going to collections.
 

carofl93

Member
I have decided to see if the ambulance company (county EMS) can either get a copy for me or if I can sign the release for PHI to allow them to directly send the trip report to Tricare.
 

Zigner

Senior Member, Non-Attorney
Why not have the trip report sent to you and then you send it to Tricare?
 

carofl93

Member
UPDATE

I wanted to give an update on the situation. I contacted the EMS office locally and asked if they could send the trip report. They sent it to Tricare and after what seemed like forever, it was processed and paid. The person in the local billing office said that they are not happy with the billing company. The local office was a joy to work with. Everything is paid and all is well. I learned a valuable lesson in making contact directly.
 

adjusterjack

Senior Member
Happy to see that things worked out.

Understand that hospitals and medical providers hire billing companies so they don't have to deal with billing and typically don't care about what happens as long as the money keeps flowing in and they don't have to deal with irate patients.
 

Find the Right Lawyer for Your Legal Issue!

Fast, Free, and Confidential
data-ad-format="auto">
Top