Dispute medical bill or let that erroneous $1,097 bill slide (because, let’s be real, I’ve got a gazillion other things vying for my time)? Read on for how I managed to get this charge taken OFF of our account after a 7-month long battle.
I just finished watching The Bridges of Madison County yesterday, so can't really be held accountable for my emotional state for at least the next week (*cue the tears*).
But indulge me for a minute here, because this could happen to you. Not only could it, but since starting this 7-month long battle with our doctor’s office + our insurance company, I’ve learned that many of you are facing your own erroneous or just plain bizarre medical bill battles as well.
You know, like getting sent to a debt collection agency when you've already paid your medical bill? Or, being billed over a year after the fact (talk about zombie debt coming to bite you!) …for a preventative care appointment that is 100% covered under Obamacare?
I know, unreal. And yet we lived it.
After logging more than 15 hours on the phone with both our insurance company and our doctor’s office, I'd like to explain what the heck went wrong.
Then I’ll even share with you the actual letter I wrote to dispute medical bill that got us out of this $1,097 hell hole.
Doctor Appointment with Changed Insurance
Within a month of us welcoming our baby into the world, my husband had gotten a new + improved job. So, we switched insurance companies with an effective insurance start date of 12/07/2015 for each of us.
Except that one thing happened: our insurance put the wrong effective date (01/01/2016) for our son into their system. But that's a tidbit of information that becomes more important later down this article.
On 12/10/15, my son had his 2-month, preventative-care appointment.
As we were checking in for the appointment, it popped up that we owed $232.70 from a previous bill at the hospital (probably his pediatrician coming to visit him). I paid this with my Mastercard.
Our Doctor Sends in the Claim to Wrong Insurance Company
Our doctor’s office makes a mistake and sends this $1,097-claim into the old insurance company, even though we had updated them with our new insurance information.
Fast forward over a year later, and the old insurance company finally gets smart on this. They ask for a refund of the insurance amount.
At that point, our doctor’s office submits the 13-month old claim to our current insurance company, Cigna.
Except there's a problem; it gets denied because of the errant effective date showing 01/01/2016 for my son.
My husband makes several phone calls into our new insurance company + his HR department, and resolves this issue. We're issued a letter – and send it to our doctor’s billing office – showing the correct effective date is, in fact, 12/07/2015.
Our doctor's billing office then resubmits the claim.
They get denied again.
The issue? Per their contract with our insurance carrier, they only have 90 days after an appointment to submit the actual claim paperwork.
Of course there's one problem with this scenario: they weren't told by our old insurance company that the claim had been denied until 13 months after the appointment.
And then things got really interesting.
Trying to Collect On a Debt Paid a Month Earlier
I get a letter in the mail from the doctor’s billing department saying that I owe them $118.59. It just so happens that I had already paid $118.59 just a month earlier. Like, to the penny.
This was for an appointment I (Amanda, not my son, Conner) had in January.
Instead of taking that money and putting it onto my account, they took it and put it on Conner’s $1,097 pending claim with insurance. So, it appeared as if I was overdue on my own medical bill.
After speaking with a manager, they were “allowed” to credit that money back onto my account, and not on my son's.
Honestly, I didn't think it'd be legal for them to have done that in the first place.
And then it gets even more interesting (and by more interesting, I really mean more painful to deal with).
Trying to Collect on an 18-Month Old Debt that I Already Paid
Since I was being told by the doctor’s billing department managers that I had to pay this claim because I had signed a document saying I would pay whatever insurance did not (you know that document your doc’s office gets you to sign while you’re standing in line, with a fever? Yeah, it contains some juicy stuff).
I called our insurance company, and had an expedited claims review order put through. We had a three-way call with someone at the doctor’s billing office who said she would send over the paperwork showing the initial claim to the wrong insurance company.
When that old insurance company kicked back the claim and asked for a refund, for some reason these guys took $232.70 that I had paid towards that other appointment (you know, before my son’s appointment even took place back in December of 2015?), and put it on this $1,097 preventative care claim.
Which resulted in me getting another call from their billing department out of the blue, from another person who didn't know what was going on, and said I owed them $232.70.
After she figured out what our Doc's billing system was doing to us – taking money we had paid onto other claims and putting them onto this $1,097 pending insurance claim – she said that we would need to wait until the claim came through from insurance, then this amount of $232.70 would go back onto the bill it was supposed to be on.
Except then, they did something really sucky. They sent us to collections.
Receiving the Collection Notice
I received a letter from a collection agency, asking for (you guessed it): $232.70.
To say I was seeing red would be putting it lightly. I think I was seeing a deep, deep, merlot. With hints of B.S.
I called our insurance company again, and this time put in a Patient Appeals Form over the phone. The woman thought we had a shot because − even though the other claims appeal was denied because our doc had sent in the claim beyond 365 days after sending it into the wrong company − it showed that the old insurance company did not ask for the refund until January 18, 2017.
We then three-wayed with a woman in the doctor’s billing department, who brought up the $232.70 issue. She said she would speak with her supervisor about putting it back onto the bill that had been sent to collections, since this claim was being appealed with insurance.
While waiting, I went to my trusty filing cabinet, and within 5 minutes was able to locate not only the actual receipt of the $232.70 from that day, but also the next billing statement from our Doc's showing that the $232.70 had been credited to our account.
And within three hours I got a call that our doc's billing department decided that because the payment had been back in 2015, they could not put it onto the original bill it was meant for and take it off of the preventative care appointment.
You know, the one that is 100% covered, not-even-a-copayment-due under Obamacare?
I waited on a call back from a supervisor to enlighten me as to exactly why they took that money that was on another bill, and applied it to a preventative care appointment that was pending with insurance.
Fortunately for us, I got a voice mail several days later from someone else who said they would take us out of collections and apply the funds properly.
The Review Comes Back Denied, but With Some Enlightening Information
While Cigna denied the claim, again, based on the time period being far over to submit a claim, I got what I needed from that review process. On page three, I saw a glorious paragraph that said (bold underline is my own),
“A0 – HEALTH CARE PROFESSIONAL: THIS CLAIM WAS NOT RECEIVED ON TIME SO WE CANNOT PAY THE CLAIM. YOUR CONTRACT WITH CIGNA DOES NOT ALLOW YOU TO BILL THE PATIENT AFTER THE TIME LIMIT. IF YOU DID SUBMIT THE CLAIM ON TIME, PLEASE RESEND THE CLAIM ALONG WITH PROOF OF TIMELY SUBMISSION TO THE ADDRESS ON THE PATIENT'S ID CARD. PLEASE REFER TO YOUR CONTRACT FOR INFORMATION ON CLAIM FILING DEADLINES.”
Cigna also told me that the claim review process iis sent to the doctor’s billing department as well.
Problem solved, right?
The Doctor Bills Us…Again
No. One month after this claims appeal result was sent to both me and their billing department, they gloss over this information and instead send us another bill for the $1,097.
Things Turned Around When I Took Matters (Even Moreso) Into my Own Hands
I FINALLY found a Patient Liaison Officer within the doctor’s corporate headquarters, where you're supposed to send in issues like this that just can't be resolved with the administration in the doctor’s office branch you're going to.
So, I spent another hour or so writing them a detailed, professional letter of the exact issues going on and why they should clear my account because we clearly did not owe the $1,097. Then I sent this letter to them certified, with receipt.
Get your copy of the exact letter I wrote to the doctor’s Patient Liaison Officer that got us out of the $1,097 medical bill + a breakdown for why it worked. Essentially, this letter was worth $1,097 to us! Plus a whole lot of sweat + tears. It’s yours, free. Not to mention I’ve got a lot of experience in writing these professional and regulations-sounding letters working at the Texas Commission on Environmental Quality for four years.
The Saga is Over
Can I just tell you how much I used to love getting the mail, and for the last six months I’ve cringed when thinking about going to the mailbox? So much so, in fact, that I only got the mail once a week.
That’s just a symptom of this whole fiasco.
I didn’t hear from the Liaison officer for a month, and was afraid to ask. Finally, we were forced to make a doctor appointment when my son had fallen off the bottom step at the playground and we thought he would need a stitch (thankfully, he didn’t). I took the opportunity and asked the woman at the doctor’s office to check his account and see what was going on.
She said that on July 12th, just six days days after that letter was sent, they had cleared my account and attempted to call me to tell me the decision they’d reached.
I cannot TELL you the relief this gave me. And to think, I had still been cringing to go to the mailbox for the last month when I could’ve just called them to find this information out and saved myself extra stress + worry!
Learn from this + my mistakes, and get this resolution letter. You never know when you will need it.