Health Insurance Question

Vince, Pt. II · 12-19-2012, 02:54 PM

Earlier this year (February-ish, I think), I took a golf ball to the dome. After a couple days when the headache wouldn't go away, I went to the ER and had an MRI done, revealed a minor concussion, no biggie. I had lost my wallet the day before, so I didn't have my health insurance cards. The lady behind the counter said they could look up my insurance information via my social, so they did, no big deal.

Got a call today from a debt collection agency claiming I owe the hospital $4,000. Apparently they never found out my insurance information, and their correspondence hasn't reached me (I have moved in the interim, so that is a plausible explanation). I have the same insurance as I did back when this all happened. Before I call up my insurance company to sort this out, is there anything I should know? Is my insurance company (Anthem Blue Cross) going to do anything, and are they even required to do anything? Or am I going to be stuck with an awesome Christmas Present?

stevew · 12-19-2012, 03:10 PM

Ouch

My unofficial motto is "never trust an hourly employee"

Marmel · 12-19-2012, 03:13 PM

You should be fine. Tell your insurance company the hospital forgot to submit the bill to them and you are just finding this out now. It might take a few phone calls and a bit of your time, but no worries.

molson · 12-19-2012, 03:18 PM

I wonder how long she bothered to try to find your insurance info. I'm going to say 0 minutes.

BYU 14 · 12-19-2012, 03:38 PM

Actually insurance companies as a rule have timely filing guidelines that vary from 6-12 months as a general standard. Because of this it may not be as simple as just having a claim sent in as it could be denied.

The first thing I would do is call your carrier and ask what their timely filing guidelines are. (I have never worked for BC/BS so I don't know their standard)

If you are past timely filing you are going to need to send a letter with the claim (and I would get a copy of the claim from the Hospital and mail it yourself) Tell the hospital you need a UB04 and an itemized statement and send that in with your letter explaining the situation.

If the claim is still denied you can then file a formal appeal or request the Hospital do so since they did not bill the claim. I would also talk to someone in management in the billing office and let them know what happened and if it does not look like the insurance will pay either initially or after appeal, request they write the charge off.

Again, if BCBS has a 12 month filing deadline this is all moot, but make sure they (the Hospital) verify your coverage and send the claim if you are still within timely filing, or as mentioned above get the information yourself and file if you do not trust them.

sterlingice · 12-19-2012, 03:45 PM

BYU 14: Is this you?

SI

BYU 14 · 12-19-2012, 04:19 PM

Quote:

Originally Posted by sterlingice

BYU 14: Is this you?

SI

LOL, it feels like it some days

stevew · 12-19-2012, 04:57 PM

Quote:

Originally Posted by molson

I wonder how long she bothered to try to find your insurance info. I'm going to say 0 minutes.

Vince-I don't have my card
Girl-I can look your info up

Vince(in pain)-ok

Girl-

....Looking....

Other person in office-Did you watch Real Housewives?

Girl-OMG, like totally, i can't believe that bitch.

Vince, Pt. II · 12-21-2012, 11:55 AM

Thanks for the advice. Going to tackle this when I get off work today, hopefully it goes smoothly.

stevew · 12-21-2012, 10:43 PM

Don't be afraid to channel Jules Winnfield if you have to.

Desnudo · 12-22-2012, 04:41 PM

God the health care system is royally fucked up. Every step is designed for you to make a mistake that costs you a lot of money and you're dependent on a bunch of filing clerks to make sure all the i's are dotted and T's crossed. I can't offer any help, but at least know you aren't the only one that has had to deal with this kind of bs before.

Flasch186 · 12-22-2012, 10:46 PM

Anyone else looking at this thread thinking how screwed up the health care system is and its most likely the system's fault and not one individual with Sleep Apnea?

(Love for BYU)

BYU 14 · 12-23-2012, 12:30 PM

Quote:

Originally Posted by Flasch186

Anyone else looking at this thread thinking how screwed up the health care system is and its most likely the system's fault and not one individual with Sleep Apnea?

(Love for BYU)

LOL, honestly I sometimes just want to walk away and start fresh in a new career, especially working for an administrator of State Medicaid now. You think commercial carriers are bad......Medicaid is an entirely new and special level of frustration!

But alas I have 22+ years in this field, so it will probably be the field I retire in. And, the actual company I work for now is awesome.

But I agree, dealing with insurance for many folks is daunting, if not near impossible.

12-19-2012, 03:13 PM	#3
Marmel Grizzled Veteran Join Date: Oct 2000 Location: Manchester, CT	You should be fine. Tell your insurance company the hospital forgot to submit the bill to them and you are just finding this out now. It might take a few phone calls and a bit of your time, but no worries. __________________ 81-78 Cincinnati basketball writer P. Daugherty, "Connor Barwin playing several minutes against Syracuse is like kids with slingshots taking down Caesar's legions."

12-19-2012, 03:38 PM	#5
BYU 14 Coordinator Join Date: Jun 2002 Location: The scorched Desert	Actually insurance companies as a rule have timely filing guidelines that vary from 6-12 months as a general standard. Because of this it may not be as simple as just having a claim sent in as it could be denied. The first thing I would do is call your carrier and ask what their timely filing guidelines are. (I have never worked for BC/BS so I don't know their standard) If you are past timely filing you are going to need to send a letter with the claim (and I would get a copy of the claim from the Hospital and mail it yourself) Tell the hospital you need a UB04 and an itemized statement and send that in with your letter explaining the situation. If the claim is still denied you can then file a formal appeal or request the Hospital do so since they did not bill the claim. I would also talk to someone in management in the billing office and let them know what happened and if it does not look like the insurance will pay either initially or after appeal, request they write the charge off. Again, if BCBS has a 12 month filing deadline this is all moot, but make sure they (the Hospital) verify your coverage and send the claim if you are still within timely filing, or as mentioned above get the information yourself and file if you do not trust them. Last edited by BYU 14 : 12-19-2012 at 03:40 PM.

12-19-2012, 03:45 PM	#6
sterlingice Hall Of Famer Join Date: Apr 2002 Location: Back in Houston!	BYU 14: Is this you? SI __________________ Houston Hippopotami, III.3: 20th Anniversary Thread - All former HT players are encouraged to check it out! Janos: "Only America could produce an imbecile of your caliber!" Freakazoid: "That's because we make lots of things better than other people!" Last edited by sterlingice : 12-19-2012 at 03:46 PM.

12-22-2012, 10:46 PM	#12
Flasch186 Coordinator Join Date: May 2002 Location: Jacksonville, FL	Anyone else looking at this thread thinking how screwed up the health care system is and its most likely the system's fault and not one individual with Sleep Apnea? (Love for BYU) __________________ Jacksonville-florida-homes-for-sale Putting a New Spin on Real Estate! ----------------------------------------------------------- Commissioner of the USFL USFL

12-19-2012, 03:10 PM	#2
stevew Hall Of Famer Join Date: Dec 2003 Location: the yo'	Ouch My unofficial motto is "never trust an hourly employee"

12-19-2012, 03:18 PM	#4
molson General Manager Join Date: Oct 2002 Location: The Mountains	I wonder how long she bothered to try to find your insurance info. I'm going to say 0 minutes.

12-21-2012, 11:55 AM	#9
Vince, Pt. II Pro Starter Join Date: Sep 2009 Location: Somewhere More Familiar	Thanks for the advice. Going to tackle this when I get off work today, hopefully it goes smoothly.

12-21-2012, 10:43 PM	#10
stevew Hall Of Famer Join Date: Dec 2003 Location: the yo'	Don't be afraid to channel Jules Winnfield if you have to.

12-22-2012, 04:41 PM	#11
Desnudo Coordinator Join Date: Jul 2003 Location: Here and There	God the health care system is royally fucked up. Every step is designed for you to make a mistake that costs you a lot of money and you're dependent on a bunch of filing clerks to make sure all the i's are dotted and T's crossed. I can't offer any help, but at least know you aren't the only one that has had to deal with this kind of bs before.

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