Medical Billing Forum

Payments => Patient Billing => Topic started by: tigvatim on August 08, 2015, 04:53:45 PM

Title: Out of Network provider billing
Post by: tigvatim on August 08, 2015, 04:53:45 PM
I am disabled and am covered by Medicare Parts A & B.  I also must maintain my employer's group health plan as I am still considered an eligible employee.  This plan is secondary to Medicare but does not operate as a Medicare supplement plan.

One year ago, a sleep physician diagnosed me with apnea.  His office asked if I had a preference on what company to use as my CPAP provider.  I wrote on their questionaire form any provider that is within BOTH of my insurance plans.  Now I receive a bill from American Home Patient for CPAP equipment charges through January of 2015 totaling over $1000.  It turns out they are not in-network with my secondary insurer.  Medicare paid 80% leaving me responsible for the remaining 20%.  American Home Patient did not file the first claim with Medicare until December of 2014.  At that time, they submitted all bills from June through December.  They just now sent me a bill for the remaining balance.  I know I will later receive more bills for January through the present.

Had they billed Medicare promptly and then billed me promptly, I would have discovered this issue well before this bill grew to this amount.  Subsequent monthly charges were submitted to Medicare timely but American Home Patient still has not billed me for those months.  I feel that they deliberately delayed billing me until the 13th month billing cap that Medicare imposes on this type of equipment had been achieved.  Thus, denying me the opportunity to switch to a provider that is within my network.  Additionally, American Home Patient contacted me in mid January stating it was time for replacement parts to be ordered,  I asked then if all this is covered by both carriers.  I was told that since I had not received a bill from them by that time, it must be fully covered.  I authorized the purchase of the replacement parts.  I am still awaiting that bill as well.

Do I have ANY recourse?  Thanks in advance.
Title: Re: Out of Network provider billing
Post by: Michele on August 30, 2015, 03:38:14 PM
Sorry for the delay in answering!  Missed your question.

Anyway, you are in a tough position.  I would recommend contacting the billing department and expressing your concerns to them.  Although I don't think that is going to get you very far.  I would also contact your secondary insurance carrier and ask them if there is any recourse for you through them.  I'm afraid there isn't much you can do but I would start there and see where you get.

Keep us posted!