I see a physician specializing in sleep medicine for sleep apnea. I need to see him once a year to continue to receive my CPAP supplies. When I went this week…surprise! They say I owe them $900 from previous visits dating back to 2022.
Relevent facts:
• I have never received a bill for any of this
• I switched insurances in March of 2023, when I retired and went on Medicare
• I got the impression that they were doing me a favor in seeing me this time with this unpaid balance and I suspect that, if I don’t settle it before my next visit (a year from now), they will not see me.
Their suggestion is that I contact my (old) insurance company. I have not done that yet, but I can’t imagine that they will be falling over themselves to assist someone who is no longer a member.
In my experiance your old insurance is obligated to settle any claims that happened while you were insured by them. I’ve successfully had former insurance “negotiate” outstanding bills after my company swithed over to new insurance. I’d start with them.
Still, its strange that a bill from 2022 is just now showing up. Did they give you a reason why this never got run through your insurance in the first place, or why they never notified you? Most likely they are going to blame Covid and the lack of personnel to process claims correctly at the time. But billing should have been the one thing that kept going during Covid, as those people in the healthcare field could actually work from home.
Tell the Dr office to re-run the claim with the insurer that was covering you at the time of the claim. Then just wait. Claims run-out can take a while and the insurer knows this. Many times it takes more than one try to get the insurer to pay a legitimate claim, even when you are a current member. However, if your treatment was not covered under your policy, then you will be on the hook - determining that may take some back and forth.
It’s still a bad look for the Dr to give you a suprise bill like that, no matter what the reason. I’d take my business elsewhere and tell them why.
I was covered under an insurance plan that ended. So Medicare became my primary. I explained this to my doctor, hospital, etc. Everyone knew. Medicare still rejected my claim saying that I had other coverage. Everyone involved knew that the old coverage had ended.
Except Medicare. I had to contact them directly and have the old insurance removed and Medicare rebilled. Everyone I was dealing with had it correct, but I needed to contact Medicare directly.
If you contact Medicare you will be on the phone for about an hour before they will tell you the Real phone number to call for payment adjustments.
That number, not the main Medicare number, is 855-798-2627. Call them and they will fix things on their end and your provider can re-bill.
I suppose the longer it has been since you had the old insurance, the less helpful they will be, but I can attest to the fact that you can deal with previous insurers to solve snafus.
I just did - to my dismay, I recently received a bill for over $400 from my ophthalmologist, noting that coverage had been denied by an insurer who I had recently dropped due to switching to Medicare.
I called the insurer and ended up having to also phone to the billing company to which the doctor outsources invoicing and the doctor’s office. So, kind of a hassle and it probably took half an hour or more. But all but $18 of the charges went away, so it was worth it.
Funny thing is it just happened again - a checkup in January under the old insurance wasn’t covered, and I’m only being told about it now. So, I’ll be back on the phone again soon. Wish me luck.
ETA: and a post-script I’m sure we can all agree with: the American health care system is unbelievably effed up. What a joke this all is.
Forgive me for being the bearer of bad news. Medicare alone will not completely cover your medical bills. You will absolutely need a Medicare supplemental policy (or whatever the hell they call it.). There are many available. Please do not pick the one with the lowest monthly cost. That’s what Mr VOW’s sister did, and her copays are atrocious.
The “commercials” on TV tell you some plans even give you money back every month. Check out the government website which shows every plan available to you, and compare them. You don’t need to find out that providers want a couple hundred bucks before they’ll even look at you!
Bottom line: Medicare alone doesn’t pay for everything.
And don’t be suckered into one of those things called a “Medicare Advantage” plan!
That is the insurance industries attempt to eventually privatize Medicate by fooling people into switching to one of these private plans rather than real Medicare.
This happened to me once without Medicare or changing insurance being involved at all. After I called my insurance company it was fixed. Turns out the contract between my insurance and participating providers required them to bill within X months of service. They took longer, insurance denied the claim because of the delay and they billed me two years after the service. Except the contract prohibited that , too.
Sounds kind of like a “surprise billing” issue. But I think that only pertains to providers utilizing out of network services that then surprise patients with full price bills.
Read the code next to the amount the insurance company is denying.
This is found on the “Explanation of Benefits,” or EOB.
If the footnote with the code number says, “Bill submitted too late,” first make a copy of the EOB and then make a trip to the doctor’s office. Talk to the Office Manager, the Head of Accounting, orwhoever handles the billing. You’ll need the head honcho.
Politely say, “This is your problem, not mine.” The doctor’s office may petition the insurance company for reconsideration, and it may or may not be paid.
If the next EOB still shows nonpayment, you then request Billing to remove the charge.
It can turn out to be a messy, drawn-out hassle. Stay with it. It’s the doctor’s office screwup, and they have to eat it.
So one bit of fuckery from US health insurance ( fuckery being the main product of the US healthcare industry, which it produces in spectacular amounts ) we encountered recently-ish, is this. My wife had insurance through her job, but they laid her off and so she went back on my insurance, or so we thought. It turns out since her previous job never let her insurance company know she’d left, all her claims were being denied by my insurance (even though we were told when she took the new insurance it would be secondary) and so she was sent a bunch of huge bills.
No idea if this might apply here but FYI. I’m sure there are a hundred other types of insurance fuckery that could be causing this.
This is what happened to my wife, she’d been going to provider for a few months after losing her job ( she was only employed a few months so never actually visited that provider on her insurance from her job) then one day they were like “oh yeah here is this huge bill”. It took a bunch calls and hassle to work out what was going on and many many more over months (while convincing the provider not to send it to collections) to get it sorted. But remember we can’t have universal healthcare or we’d have to deal with a faceless bureaucracy to get healthcare
Another possibly relevant story that happened to us is my daughter’s pharmacy sent a bunch of bills, even though she has Medicaid as secondary insurance which should have covered whatever was left to pay after my primary insurance. But it turns out there are requirements to get a claim paid by Medicaid that are stricter than private insurance, and basically the pharmacy couldn’t be arsed with that and just sent us the bill.
We did a runaround with a laboratory which didn’t want to fiddle with a secondary insurance. They had been given the information about the secondary insurance several times. I got disgusted and just paid the damned bill.
When I told our family doctor about the hassle, she got mad and told me to not pay the lab again. I don’t know who she yelled at, but we never got another bill.
I give lots of samples. Way more than you wanna know about. I have fought with all the labs in the area. They all hate me.
I tell them up front at this point “I will not pay this bill EVER, you will have to sue my estate, when im dead, before you see a penny!”
My insurance covers all my labs.
If they want to work with me I’ll tell them how to file it so they are paid in a reasonable time.
I get the “we’ll turn it over to collections” speech.
I don’t care. I still won’t pay.
If they want their money they have to work with me and my confusing insurance.
60 months after my grandmother died, 60 bills, in 60 envelopes, arrived at my parent’s house. The nursing home where she died was charging for the month of care after her death. Somehow, there was no bill while the estate was being settled, and when someone realized it years later, they printed out a bill for every month, showing the balanced rolled forward, and sent them all.
It may have been a legit bill: five years later, my mom couldn’t remember if they had been paying forward or backward. But after fove years, it seemed like a them problem. She ignored it.
This one also worked out. The insurer said, “have your doctor re-submit the claim using a different code - a physical is covered, but the code your provider used, for screenings, isn’t.” So, I called the doctor’s office, explained the problem, and they said, “no worries - we will resubmit with the code for a physical.” (You would have thought they’d have known to do it correctly in the first place, but it is a newish practice; maybe the admin personnel are still learning the ropes.)
Probably took about 15 minutes this time, so well worth it, even though I loathe dealing with stuff like that.
) we encountered recently-ish, is this. My wife had insurance through her job, but they laid her off and so she went back on my insurance, or so we thought. It turns out since her previous job never let her insurance company know she’d left, all her claims were being denied by my insurance (even though we were told when she took the new insurance it would be secondary) and so she was sent a bunch of huge bills.