Medical Bill Dispute.

Cherokeekid88

Cherokeekid88

Well-Known Member
Joined
Jun 30, 2007
Location
High Point, NC
So long story short, August of 2020, my wife had a colonoscopy. She was told by the Dr that it would be covered by insurance. She called her insurance and they also informed her that it would be covered if the Drs. office coded it a certain way. The day of her procedure, she confirmed again that it would be covered. Well, we ended up getting a bill for $1600. she called and they again informed us that it was coded wrong and it would be taken care of. Received yet another bill wanting payment, called insurance this time and they said that the Drs office coded it correctly, but BCBS did not. Fast forward over a year, we have not heard anything from anyone. No bills in the mail, no phone calls, nothing. Well now, it has been sent over to a debt collector and got a bill for the first time today. I don't know if called the Drs office and the insurance company is going to do anything or not because it seems like they just pass the blame. Looking for any advice on how to dispute this. I know it says I can write them a letter to dispute, but don't know how well that's going to work.
 
It sounds like it was covered by insurance. I'd imagine 1600 was your co-pay.
 
It also depends whether or not this was a preventative procedure. For the half dozen colonoscopies I have had I think I only paid a copay on one, and that was directly before having a portion of the colon removed. That bill blew the maximum out of pocket out of the water so it didn’t really matter at that point.
 
thecj3man said:
It also depends whether or not this was a preventative procedure. For the half dozen colonoscopies I have had I think I only paid a copay on one, and that was directly before having a portion of the colon removed. That bill blew the maximum out of pocket out of the water so it didn’t really matter at that point.
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The Drs. told us there were two ways they could code it. one being preventative and the other being something else and that given my wife has IBD, they said it would be covered 100% since she has a preexisting condition and wasn't just "because"
 
The calls should continue and your insurance company should call the provider and the collection company to resolve it. All that said, as far ad the provider goes, you are ultimately responsible. To them, after a certain amount of time, you didn’t pay your bill.

I hope you get it handled.
 
Cherokeekid88 said:
So long story short, August of 2020, my wife had a colonoscopy. She was told by the Dr that it would be covered by insurance. She called her insurance and they also informed her that it would be covered if the Drs. office coded it a certain way. The day of her procedure, she confirmed again that it would be covered. Well, we ended up getting a bill for $1600. she called and they again informed us that it was coded wrong and it would be taken care of. Received yet another bill wanting payment, called insurance this time and they said that the Drs office coded it correctly, but BCBS did not. Fast forward over a year, we have not heard anything from anyone. No bills in the mail, no phone calls, nothing. Well now, it has been sent over to a debt collector and got a bill for the first time today. I don't know if called the Drs office and the insurance company is going to do anything or not because it seems like they just pass the blame. Looking for any advice on how to dispute this. I know it says I can write them a letter to dispute, but don't know how well that's going to work.
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I'm literally Going through the exact same scenario. I had a colonoscopy in March of last year and kept getting told that it was coded wrong after they confirmed that It will be fully covered even the day off. I'm still fighting with the insurance company to get it covered.
 
Go ahead and pay it if you can. Don't let a collection go on your credit report. If it's not too old, pay the practice, and let them cancel the debt with the collection agency. If you finally get a decision in your favor, BCBS will cut you a check for the amount.

Renee and I both had surgery last year. Just last week, we got 2 refund checks from BCBS, one for about 950, the other 200, on bills we had to pay before they finally settled with the practice.


BTW, for future reference, and what hits a lot of folks hard....the "no surprise billing act" took effect January 1st. Basically, the hospital is now prevented from charging you any more than in-network rates for an out-of-network providers. Commonly ER docs, anesthesiologists, DME suppliers that might provide services thru the hospital are not "in network", and you have to pay the balance between rates yourself. We got hit hard on some stuff last year, especially with Renee's knee.
 
kaiser715 said:
BTW, for future reference, and what hits a lot of folks hard....the "no surprise billing act" took effect January 1st. Basically, the hospital is now prevented from charging you any more than in-network rates for an out-of-network providers. Commonly ER docs, anesthesiologists, DME suppliers that might provide services thru the hospital are not "in network", and you have to pay the balance between rates yourself. We got hit hard on some stuff last year, especially with Renee's knee.
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A lot of folks get surprised when they get a bill from the ambalamps thats is out of network rate, just depending on who happened to answer the call.
 
kaiser715 said:
Don't let a collection go on your credit report
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If it has been placed with a debt agency, it already shows as a collection on his report. It can be reversed however by the insurance working with the agency.

Just paying the agency WILL NOT remove the collection from your report @Cherokeekid88. The agency can contact the reporting bureaus to have it removed and likely will if the insurance company gets involved and works with you.

Back in 2010 or so I had a buddy go through a similar thing. It took months to resolve but eventually it was.

———

In 2019 I was 49 and went to a proctologist for some blood in the toilet. Without examining me, she wanted to do a colonoscopy and I told her my insurance would only cover it once I was 50 (my wife had had hers as she is a couple of years older).

She told me that they would cover it and scheduled it. I called the insurance and they told me that without an examination or history of colon cancer in my family that I would be responsible for 100%. I cancelled the scope and fired that doctor.

Found a new doc, had roid banding. All was well.

I turned 50 in 2020, had the scope and it was 100% covered. Squeeky clean btw, not a single issue 😃
 
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Yeah unfortunately, its already with a debt collector... I mean we literally have heard nothing for over a year. Never received a bill from the Dr after our last convo assuring us that it was coded wrong and would be covered 100%. I am going to write them a letter to dispute it and get my wife to call her insurance company and the drs office and get to the bottom of it.
 
I had the same thing happen for the same procedure. they told me that since they removed a polyp it was not considered routine. I informed them that there was no polyp during the routine and it was coded wrong. They finally agreed with me. This took numerous calls to the insurance company and to the doctors office as well as a lot of follow calls checking on status of the claim until both parties confirmed it was paid in full. It was a huge hassle, but I knew what the result would be if I just ignored it. I would be calling them both on a daily basis to get answers and stay on top of it. Squeaky wheel gets the grease. Also use this for a learning curve moving forward on doctor bills. You have to stay on top of them as all times to make sure the charges are correct and bills are paid. I am going through this now from my last round of surgeries. Think I have them all paid and another shows up out of the blue. Good luck.
 
Forget the collection company. Dr office sells their debt in bulk.
Did work for a guy in CLT that owned one of these companies. The going rate is .025per dollar. So they'd buy $250,000 in debt chunks for $6k. Then they'd pay their collector 40% of anything he collected. Everytime they 15k in debt they bought another chunk.

Im assuming the business was good. Dude had an oceanfront house in Marthas Vineyard and a house in Vale

Anyway...if you call the Dr office back they can recall the debt. The debt comany will gladly hand it back because they will realize you arent going to pay and anything they get from the doc is better than nothing.
 
Ron said:
Forget the collection company. Dr office sells their debt in bulk.
Did work for a guy in CLT that owned one of these companies. The going rate is .025per dollar. So they'd buy $250,000 in debt chunks for $6k. Then they'd pay their collector 40% of anything he collected. Everytime they 15k in debt they bought another chunk.

Im assuming the business was good. Dude had an oceanfront house in Marthas Vineyard and a house in Vale

Anyway...if you call the Dr office back they can recall the debt. The debt comany will gladly hand it back because they will realize you arent going to pay and anything they get from the doc is better than nothing.
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I like that.
 
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