Author Topic: Medical Biller & Collection  (Read 1016 times)

Unununium

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Medical Biller & Collection
« on: April 16, 2013, 07:10:11 PM »
Hi,

I recently took my wife to the emergency room. The hospital billed our insurance, the radiology department billed our insurance, however the physician billed us as uninsured. They sent one letter which they claimed was returned, though they have our correct address and phone number.  Without calling, they sent us to collection. I would like them to bill our insurance and retract the submission to the collection agency. They are claiming that I should go through the collection agency, though my insurance provider is stating that the collection agency cannot bill them. Can anyone provide some advice? I would think that the responsibility is on the biller since we provided all the correct information.

thank you!

RichardP

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Re: Medical Biller & Collection
« Reply #1 on: April 17, 2013, 01:30:56 AM »
Could you specify whether you are talking about the emergency room doctor.  And can you tell us if you have spoken directly with the doctor, his staff, or his billing service?  In the meantime:

The responsibility for making payment for services rendered to your wife most likely lies with you.  If you signed paperwork in the emergency room, chances are that you signed an agreement to be responsible for payment for those services rendered.

Providers who participate as Medicare doctors are required to file an insurance claim on behalf of the Medicare patient they see.  So far as I know, doctors are not required to file insurance claims on behalf of anyone else.  They are free to require payment from the one who is financially responsible for the patient.  Doctors are also free to send the responsible party to collections if they don't pay for the services rendered.

If a doctor chooses to not bill your insurance carrier for you, you cannot force him to.  All you can do is pay your bill (or make monthly payments) and send a copy of the doctor's fee slip to your insurance carrier for reimbursement.

You might contact the doctor's billing service if you haven't talked with them already.  Explain your situation, tell them what insurance you have, ask if they are a participating provider, and ask if they would consider billing the insurance company for you.  If they won't submit a bill for you to your insurance carrier, you might ask if you could make monthly payments.  If you have spoken with the billing service, but not with the doctor, you might try to talk to the doctor and tell him how his billing service is handling you.  He can't know these kinds of things unless he gets feedback from patients.

PMRNC

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Re: Medical Biller & Collection
« Reply #2 on: April 17, 2013, 07:01:02 AM »
Quote
I recently took my wife to the emergency room. The hospital billed our insurance, the radiology department billed our insurance, however the physician billed us as uninsured. They sent one letter which they claimed was returned, though they have our correct address and phone number.  Without calling, they sent us to collection. I would like them to bill our insurance and retract the submission to the collection agency. They are claiming that I should go through the collection agency, though my insurance provider is stating that the collection agency cannot bill them. Can anyone provide some advice? I would think that the responsibility is on the biller since we provided all the correct information.

Is it possible this provider is not within your carrier network? Do you have an HMO or PPO?  I would simply just call up the physician and request a fully itemized bill and then send it to your carrier, you'll get less of a run around and Richard is right, ultimately it's your responsibility. If you have an HMO to which maybe the facility was covered as participating but the physicians services was not, you can appeal those since it was an ER visit. I would first start in getting an itemized bill and sending it to your carrier first.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com