Author Topic: Can in-network doctor bill patient for the claim denied by insurance company?  (Read 222 times)

carefornelly

  • Newbie
  • *
  • Posts: 5
We recently welcomed our baby daughter after a C-section delivery. The anesthesiologists sent three bills to our insurance company Cigna:

1. Procedure code 01961 QX, was paid by Cigna.

2. Procedure code 01961 QY, was paid by Cigna.

3. Procedure code 62322 59, was DENIED by Cigna with the following note: 1720- HEALTH CARE PROFESSIONAL ONLY: SERVICE IS DENIED. IT'S PART OF A CMS NCCI COLUMN1/COLUMN 2 EDIT THAT INCLUDES A SERVICE ON A PRIOR CLAIM.

The anesthesiologists most likely were unaware of the denial, and sent me the letter that the insurance has not paid the claim, and asked to contact them immediately to avoid possible responsibility for this balance.

The anesthesiologists filed the claim one more time. It was again denied with the reason "duplicate of an existing claim". No reference # or EOB for the second claim.

My question is can the anesthesiologists make me pay for this procedure if they are in-network and Cigna has a reason for denial?

There are terrible reviews online about their billing department, where people receive vill from them years later.

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4708
    • Solutions Medical Billing
First Congratulations!

Second, I personally would call Cigna myself and ask them to look at the claim with me.  Ask them if they paid for everything that is covered, and what the provider can bill you for.  If they are participating with Cigna then they must follow what Cigna says is your responsibility.  They should be very helpful and review the claim to see if there appear to be billing errors.  They won't tell the provider how to bill but they may give you some information to use to help the provider figure out what needs to be done (if anything).  But the best bet is to start out by contacting Cigna.

Good luck!
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com