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  1. #1
    Join Date
    Jan 2012
    Posts
    1

    Default Medical Bill from 2 1/2 Years Ago

    My question involves collection proceedings in the State of: Arkansas/Oklahoma. We had a Lab do some tests on 7/2/2009 in OK and we live in AR. When they billed our insurance it was denied because the insurance said "submitted diagnosis does not fall within the covered diagnoses for Lab procedure and is considered investigational based on primary coverage criteria" I contacted my insurance and they said the lab coded it wrong and they needed to resubmit. The lab said they did and my insurance said they didn't change anything. This happened another time. Then the lab said that it was the Dr that needed to change the diagnoses and she should write a letter to my insurance. She did and nothing happened for months. I then got letters and calls from a collection company in Tulsa. They said I should call the insurance company and the lab and get them on the phone together. The lab said they could not talk to my insurance on the phone. I then get another call from the collection company saying I should send them a payment and a letter of complaint about the whole thing. I had a kid and forgot about the whole thing and today I get a call from the collection looking for payment. I told her I forgot and got their address again. She said I should file an appeal with my insurance and the OK Blue cross insurance. My insurance's policy is appeals by 180 of notice of denial. I heard that in AR the SOL on medical bills is 3 years, but I don't know if it would be OK law or AR law when talking about the SOL. The collection company said they could not settle for anything but the total $643, as I would pay $100 for it to go away. Should I pay it out in payments, keep putting them off till July where it would be three years or is the SOL for OK longer than 3 years? Any suggestions would be helpful. Thanks,

  2. #2
    Join Date
    Oct 2006
    Location
    supratentorial region
    Posts
    818

    Default Re: Medical Bill from 2 1/2 Years Ago

    When they billed our insurance it was denied because the insurance said "submitted diagnosis does not fall within the covered diagnoses for Lab procedure and is considered investigational based on primary coverage criteria"
    The bolded does not necessarily mean it was coded incorrectly. It means your insurance company does not cover that lab test for the diagnosis code. It would be considered insurance fraud for your Physician to change a correct diagnosis code just so your insurance covers/pays the claim.

    A quick internet search found this answer:
    SOL in Oklahoma for an Open Account is 3 years from last charge or payment and a Written Contract 5 years. Medical bills are normally considered written contract, but it could be one or the other.

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