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Message
Medical Billing Question
Posted on 4/7/15 at 7:26 pm
Posted on 4/7/15 at 7:26 pm
First of all, yes I've been lurking for a long time. Didn't even realize I had previously made an account.
Anyway, I just received a letter from insurance company stating that I may owe ~$6k to an anesthesiologist for a service in Jan. 2014. It shows $0 paid by the insurance company due to code "C5- not filed within time limits". I assume this means the hospital/dr didn't file this until just recently. I've never received anything from the dr/hospital about this and I haven't moved or anything like that. I tried to call the insurance company, but of course they were closed for the day. Obviously I will call them in the morning, but I'm a little flustered by it this evening. So, how can I expect this to play out? Appeal with insurance company or call hospital? Thanks for any answers.
Anyway, I just received a letter from insurance company stating that I may owe ~$6k to an anesthesiologist for a service in Jan. 2014. It shows $0 paid by the insurance company due to code "C5- not filed within time limits". I assume this means the hospital/dr didn't file this until just recently. I've never received anything from the dr/hospital about this and I haven't moved or anything like that. I tried to call the insurance company, but of course they were closed for the day. Obviously I will call them in the morning, but I'm a little flustered by it this evening. So, how can I expect this to play out? Appeal with insurance company or call hospital? Thanks for any answers.
3
Posted on 4/7/15 at 8:17 pm to unusualname
"may" owe? what does that mean? I would wait for something more definite , there are a lot of scams going on .... works something like "we can clear this up for $100"...etc. If u do owe for this reason I would let an attorney handle it.
Posted on 4/7/15 at 8:55 pm to unusualname
It sounds like someone in the hospital was late filing a claim and gave it a shot hoping the insurance carrier would honor it anyway.
My suggestion (and no, I'm not an attorney) would be to get proactive. Email the hospital (to get it in writing), saying that your insurance carrier sent you a notice stating they tried to file a claim for services rendered on January xx, 2014 (mention the date explicitly for the record) and that you want to know what that's all about.
By doing this you are demonstrating that you aren't trying to dodge payment and also you can get their response in writing if they try to collect from you.
I don't know what your legal rights are, but will note that none of this would have mattered if you'd kept on top of things last year and noticed they hadn't filed a claim for you.
My suggestion (and no, I'm not an attorney) would be to get proactive. Email the hospital (to get it in writing), saying that your insurance carrier sent you a notice stating they tried to file a claim for services rendered on January xx, 2014 (mention the date explicitly for the record) and that you want to know what that's all about.
By doing this you are demonstrating that you aren't trying to dodge payment and also you can get their response in writing if they try to collect from you.
I don't know what your legal rights are, but will note that none of this would have mattered if you'd kept on top of things last year and noticed they hadn't filed a claim for you.
Posted on 4/7/15 at 8:56 pm to jeffsdad
That seems to be the terminology this insurance company always uses for "we paid our share and this is what is still owed to them". I guess they assume you may be able to work that number with the provider. My son was born on that date, so it makes sense, but I have no idea how this was just recently filed.
Posted on 4/7/15 at 9:01 pm to foshizzle
I definitely planned to contact them, but getting it documented in an email sounds like a good idea.
I had a few different bills from them closer to the original date and everything was paid up in full. I just never thought about a separate bill for an anesthesiologist, but I try my best to stay out of hospitals/dr offices.
I had a few different bills from them closer to the original date and everything was paid up in full. I just never thought about a separate bill for an anesthesiologist, but I try my best to stay out of hospitals/dr offices.
Posted on 4/7/15 at 9:09 pm to unusualname
As an anesthesiologist, we do bill for our services separately from the surgeon/obgyn and the hospital. Therefore, you could have a hospital facility bill, a surgeon/obgyn bill, and an anesthesiologist bill. Now why you're getting it a year late, who knows?
I do not work for the hospital so am not included in any bills from a hospital facility.
I do not work for the hospital so am not included in any bills from a hospital facility.
Posted on 4/8/15 at 12:16 pm to unusualname
quote:
Anyway, I just received a letter from insurance company stating that I may owe ~$6k to an anesthesiologist for a service in Jan. 2014. It shows $0 paid by the insurance company due to code "C5- not filed within time limits".
If the timely filing denial was a result of you (i.e. didn't give proper insurance or demographic information), then is would be reasonable to ask you to pay.
But if the untimely filing was the result of physician office error, then it is total BS to transfer that balance to patient responsibility.
My first call would be to the billing dept of the phsyicians office. Ask them when the filing date was in relation to the date of service. Ask them if they had all the appropriate insurance and demographic information at the time of service. Timely filing can be anywhere from 90 days to 1 year, so they had plenty of time to get your claim in.
If it was their fail, and they still want you to pay, just let them know you won't be paying until your insurance assigns the financial responsibility to you, or the state insurance board reviews the incident and advises you to pay.
That balance should be written off unless you failed to give them the appropriate information.
This post was edited on 4/8/15 at 12:17 pm
Posted on 4/8/15 at 1:04 pm to MSMHater
I called the insurance company first. They of course said that it was filed too late and I should contact the hospital billing dept. Hospital billing dept says they don't bill for anesthesia and forwarded me to an outside company. The billing company agreed that it looks like it was just recently filed and didn't know why. She asked for some information and said they would review it. If they find that it was actually billed late, they will hopefully have to write it off.
I'm all for paying bills that I should be responsible for, but if they expect me to pay when they didn't bill within the 1 year limit...
I'm all for paying bills that I should be responsible for, but if they expect me to pay when they didn't bill within the 1 year limit...
Posted on 4/8/15 at 2:26 pm to unusualname
quote:
As you should. I would never expect my patients to pay for my billing company's mistakes.
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