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has anyone dealt with this insurance problem

MontyMrsMontyMrs
in Success after IF

I have some bills from my RE's office which are all overages of what insurance paid vs what the clinic wants to get paid.  I called the insurance company and they assured me that I am NOT responsible for these overages since they have a contracted rate with the clinic.  DH has been dealing with the clinic and they insist we ARE responsible even though the claims have already been paid for by insurance.

He's currently waiting on a detailed breakdown of what the clinic thinks we owe and why and I have all my insurance statements proving that the insurance company paid the claims.  

If you had this issue how did you resolve it?  TIA 

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Re: has anyone dealt with this insurance problem

  • GuitaristsGirlGuitaristsGirl

    On your EOBs, under "Amount You Owe Provider" - what does it say?  $0.00??  If so, I'd send that to the clinic and tell them to figure it out :) 

    Sorry, can't be more help - I've had more than my share of insurance problems, but not this one - GL! 

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  • MontyMrsMontyMrs
    imageGuitaristsGirl:

    On your EOBs, under "Amount You Owe Provider" - what does it say?  $0.00??  If so, I'd send that to the clinic and tell them to figure it out :) 

    Sorry, can't be more help - I've had more than my share of insurance problems, but not this one - GL! 

    Yes, all my insurance bills sa  the amount I owe is 0.00.  It's very frustrating.  I think forwarding them to the insurance company is probably the only recourse I have.  I don't want bills put into collections over money that I don't legitimately owe.  grrrrrrr.

     

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  • GuitaristsGirlGuitaristsGirl

    I'd send the EOBs to the clinic.  Then, I'd take whatever paperwork you have from the clinic saying that you owe -- and file a grievance with the insurance company (with the clinic paperwork attached). 

    This isn't really a "grievance" type issue, but I've found that that getting in front of the grievance committee is the easiest, most headache-free way to make someone pay attention to you!  Also, usually, if you tell your clinic that you've filed a grievance, they'll agree to not pursue collecting until it's resolved. 

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  • MontyMrsMontyMrs
    imageGuitaristsGirl:

    I'd send the EOBs to the clinic.  Then, I'd take whatever paperwork you have from the clinic saying that you owe -- and file a grievance with the insurance company (with the clinic paperwork attached). 

    This isn't really a "grievance" type issue, but I've found that that getting in front of the grievance committee is the easiest, most headache-free way to make someone pay attention to you!  Also, usually, if you tell your clinic that you've filed a grievance, they'll agree to not pursue collecting until it's resolved. 

     

    Great advice, thanks!

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  • firsttogofirsttogo
    one handed typing here but tell the insurance comany to contact the re. we went through that and it ended up being an easy fix.
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  • browneyedgrl4282browneyedgrl4282 member

    make sure you send the EOB's and keep after them. I have had this happen to me with many medical providors! just keep harassing them, if the insurance says you owe nothing, that is it!

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  • MontyMrsMontyMrs

    Thanks for all the responses - I'm feeling much better about this problem. It seems like the clinics will try and bill you and hope you don't pay attention so they get paid what they "want" vs what is contracted.  

    I really want to clear this up before I deliver and have a whole new mess of insurance claims to deal with!

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  • BRSaugust20BRSaugust20 member

    Just wanted to confirm your RE was an "in network" provider.  If so, they are contractually obligated to accept what insurance pays.  If they are "out of network" they could balance bill the difference between what was billed and insurance paid to you.

    However, if your EOBs say you owe nothing and you are probably safe.  If it was out of network, they usually have wording that states you could owe the provider if billed. 

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  • Mrs.KiltlifterMrs.Kiltlifter
    Sending the EOB is great advice.  Also, I bet there is a law in your state in which a provider cannot charge more than what the EOB says.  So you might want to call the insurance commissioner and speak to them. 
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  • mrsolsenk12mrsolsenk12
    I am having a similar problem right now. I went for my yearly with my OB/GYN in June. Starting at the end of June, I was billed for my visit but it was insurance pending. Went this way for June, July, and August. In September, I get another bill that says that insurance wasn't pending and that we owed money. DH checked with the insurance and it turns out that my OB/GYN's office didn't file with the insurance for 3 months!! By that point, it was past time for a claim and insurance denied it. However according to insurance we don't owe anything. I am waiting to see if we get another bill for October. If we do, I am sending a copy of our EOB to them saying that we don't owe them any money.
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