Hi, I hope everyone is staying safe during these unprecedented times.
I have a question I am asking on behalf of my co-worker. You would think that because between us we have over 50 years of billing/insurance knowledge we could figure this out, but it is an unusual situation so she asked me to throw it out on the boards, with the hopes that someone else knows what she should do, because we are baffled.
In October of 2018, my co-worker's spouse lost his job because the grocery store he worked at went out of business. He had a BCBS of Illinois policy through the UCFW union, and that was the only insurance they had for the two of them and their two kids. The policy was good until 10/31/2018. He was able to find a job at another grocery store almost immediately, but his insurance would not start for 2 months. He would have the exact same insurance as before, with BCBS of Illinois through the UCFW union, once it started on 1/1/2019. It even has the exact same ID # and group #, as it is through the union.
So my co-worker went shopping for new insurance to cover the gap from 11/1/2018 to 1/1/2019, and purchased a policy that covered all 4 of them, at $800 or so a month. Lo and behold, at the beginning of November, her husband dislocated his finger, and went to a well-known, very large orthopedic practice that he had been to for knee surgery before. They have like 20 locations, and they use an out-sourced billing company in our area (with a bad online reputation, I looked them up). He presented them with his new insurance card for the policy they had just purchased, the billing company billed the claim out, and the new insurance put the charges to deductible, and my co-worker paid the bill when she got it.
This is where things get baffling.
He went back later in November and the billing company billed his old insurance with BCBS. Then they billed his new insurance for the policy they had purchased. He went back in December, and this time, they only billed his new insurance they had purchased. The claims did not process in order, so here is what ended up happening:
Old insurance paid the second claim in November at $49.22
New insurance ALSO paid the second claim in November at $49.22
New insurance put the only claim from December towards deductible, for $49.22
My co-worker had NO idea, nor did her husband, that the old insurance had been billed and paid the second claim in November, because they did not get an EOB.
January 1, 2019 rolls around, and they are now insured under the BCBS UCFW policy through the union for his new job, and they terminate the policy they had purchased effective 12/31/2018.
This past summer, my co-worker gets a bill from the ortho office (sent from the billing company address) for $49.22 for her husband's visit in December. She calls the office after they are given permission by her husband to speak to her about the bill, and she asks why it took so long to get the bill, it is almost 18 months later. She is told by the receptionist who works at the location where her husband was seen after the receptionist looks the account over that because the second date in November was paid by both insurances, it caused the bill to get stuck in the system or something. To which my co-worker says "Why did you bill the old insurance, and why did they pay? The policy was not in effect in November." They have no answer for that, so my co-worker calls the UCFW union office, and finds out, much to her surprise and dismay, that the BCBS policy NEVER went out of effect. Even though the new job said his insurance wouldn't start until 1/1/2019, it actually started on 11/1/2018, and since the deductible had already been met at his previous job (it is the exact same policy like I said before), the coverage just carried over to the new job, but two months sooner than they had been told.
So now my co-worker is ticked that they wasted $1600 for two months of coverage for a policy they purchased and didn't need, but she also finds out that the second date in November was paid by BOTH insurances for the same amount, and so she asks the billing company to take the credit and apply it to the December date of service that has the exact same dollar amount owed as the credit amount is. The billing company is ABSOLUTELY REFUSING to do this, because they are saying that either insurance that paid the claim could figure out their "error" and ask for the money back, so they want her to pay the $49.22 for the December claim, and they will "wait" 7 years to see if either company does ask back for money for the second claim in November, and if they don't, then they will send her a refund.
She has spoken to the person in charge of the billing company, and in charge of the practice, and neither will budge on what they are telling her. She has explained that BOTH policies were in effect as primary, neither insurance company knows about the other insurance company, and that neither company will ask for the money back, so just apply the credit already. She wants to take this to some type of governing authority, but we don't know who she should call. The insurance commission in our state? Or should she call both insurances and explain the situation, and have the insurances call the billing company? I have never dealt with a situation where someone accidentally paid for a private policy like they did, not realizing the previous policy was still in effect through the new job and more importantly, legitimately in effect the entire time. They paid for the two month policy out of their savings, and the work policy was paid out of his paychecks, but it is direct deposit, and he never looks at his pay-stubs online, and did not realize the insurance premium was coming out for those two months.
Sorry so long of a post, but it is just a complicated situation to explain, that to her and I seems to have a very simple solution, yet the billing company and the office don't see it like that. So any advice someone could give about how to fight this would be very welcome. At this point, she has spent more time arguing this with them then the $49.22 is worth, but it is the principle of the matter for her, and is now exacerbated by the fact that they are threatening to send her to collections, and she is out of work and on unemployment until our office reopens next month (hopefully!) due to pandemic.
Thanks!
Kristin
