Unpaid Medical Bill - Insured by BC/BS and Medicare

[donsabi]

My question involves insurance law for the state of: PA

Two years ago I was went to my local hospital with chest pains. I was stabilized and ambulanced to another hospital with cardiac care where I received a stent implant. I was insured by Medicare as primary and BCBS secondary. All providers were paid by Medicare but the doctor group at the second hospital. They claim they received a payment from BCBS but it was later rescinded and Medicare refused to pay. (I have yet to see any paperwork on this). Medicare and BCBS both state that the provider never billed them. The provider turned the bill over to a collection agency who now threatens to file suit. The provider in question is a participating provider.

I only learned of this recently when I requested a copy of my credit report. I called both Medicare and BCBS both insist they never received a bill from this provider and therefore no EOB's. The medical provider has promised to sent me copies of the EOB's but claims they must have been lost in the mail. I am awaiting another set of copies.

I realize this is a confused issue but I would like to hear comments.

[jk]

you can look up your EOB's and such online for BCBS.


If the doctors group was an "in network" provider of a PPO, they are bound by the terms of their contract with the insurer (BCBS). Generally that means billing within a prescribed time or they lose the right to collect anything, from them or the insured, for that service.

If the med group was paid and then it was rescinded, they should have documentation as to the reason. Have them provide you with the reason the payment was rescinded.

[donsabi]

Thanks for your post.

BCBS only goes back 15 months online.

Provider was a participating provider. BCBS & Medicare says they never filed and therefore no EOB's. Provider says she has EOB's but has yet to send me a copy. I have been requesting those copies for over a month now. Neither has she send me a bill.

[jk]

well, to start with, I would dispute the report on your CR.


How did the collector get involved in this. I realize you say the provider turned it over to them but apparently they had not contacted you so how did things progress to they are now threatening to sue you.

[donsabi]

jk,
Providers states she tried to contact me with information provided by the second hospital. That hospital had a record from a stress test 5 years prior and was never updated even though they copied my DL, Medicare and BCBS cards. The address was outdated by 5 years. Provider was also mailing letters to the first hospital and cardiologist at the time with reports of the procedure. The first hospital and cardio both had updated contact information. Provider could have easily obtained contact information through either one as HIPAA does not protect billing or contact information.
According to the Equifax report the first delinquency was reported by the collection agency in March 2008. The procedure was the end of Feb. 2008. Apparently the provider did not even allow 30 days to past before filing the delinquency.

I did move later in 2008 but always with a PO forwarding and SS, Medicare, BCBS were all advised promptly of my address changes.