Medical Bill Sent to Collections that Provider Never Sent to Insurance

Submitted by CookIntelligent6087 t3_z8t0tg in personalfinance

Received a call from a collection agency yesterday for a medical bill from a visit in 2020. This same provider had tons of issues with a previous visit but I was finally able to get them to resolve it with insurance after tons of hassling, so I knew something similar was up.

I called the provider and they said they submitted it to the insurance and insurance denied it for ineligibility (not true). I called the insurance and they said they never got a claim for service on that date (so there was nothing to deny). When I pressed about the previous visit, they said they submitted it over 7 months late.

Mind you, I never received anything in the mail during this whole ordeal.

I have no idea what to do now that it's in collections and neither the provider or insurance seem to want to do anything to make it right.

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ahj3939 t1_iydo2ap wrote

Medical billing is a mess. Ask me how I found out a medical claim can be so incorrect insurance can deny it and not tell you about it.

It usually boils down to if the medical provider is in or out of network with your insurance.

In network provider = usually has a contract with insurance that says they can't bill you for anything insurance didn't approve. File a complaint with your insurance.

Out of network provider = you're SOL, they can charge what they want.

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Luxferro t1_iyed898 wrote

I had a collection agency contact me once a long time ago. It was related to car insurance. I bought a different car and switched my insurance to the new car, and they increased my rates like 2X the price. I shopped around for quote right away, and easily found a place for like 1/2 the cost. I then contacted them to cancel my insurance.

Months later they sent me a huge bill, which I refused to pay because they dragged their feet canceling the insurance. Then I got a letter from a collection agency about it. I explained that I have been a loyal customer to the insurance company for X years, and always paid my bills on time. Explained that I bought a new car and they tried to rip me off, so I found a new insurance company for 1/2 the cost they wanted from me. That I had called them right away to cancel the plan with them. That I basically refused to pay their bill because they were trying to rip me off.

I never heard from the collection agency again. My credit rating has been excellent my whole life. I'm not saying you should do this, but just sharing my one experience with a collection agency.

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Bangkok_Dangeresque t1_iyefk10 wrote

>When I pressed about the previous visit, they said they submitted it over 7 months late.

Then they should be SOL. Call your insurance company again and reiterate that an in-network provider (if that's what they are) is trying to collect from you after they failed to file a timely claim despite having your information. That should get them to bring the hammer down and settle this on your behalf.

If not, contact your state health insurance regulator.

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SignificanceSpeaks t1_iyeg0xk wrote

Timely filing laws mean most offices have a year from the date of service to bill insurance and receive payment. (VA hospitals have longer) That’s why the provider is dicking you around and lying about having sent it.

Your insurance company also won’t do anything (editing, I meant won’t pay them) because legally the office can’t collect a debt over a year old.

But you do have insurance and if that provider accepts your insurance, they are legally obligated to bill them before billing you. They’re contracted into a set rate by the insurance company.

I would call your insurance company and ask the rep to stay on the line and conference in the provider to discuss this. I’ve had to do it before and the insurance reps are usually good at getting to the bottom of it.

All the best!

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