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  1. #1
    Join Date
    Sep 2013
    Posts
    6

    Question Can a Doctors Office Bill Me for a Claim They Failed to Properly Submit to Insurance

    My question involves collection proceedings in the State of: COLORADO, DOUGLAS COUNTY

    I was taken by ambulance to the hospital on Dec 2011 - the ER dept check me out and brought me via wheelchair to an eye doctor in the hosp building.
    Eye doctor resolved issue (5 times normal pressure in left eye due to previous eye dr mistake). Left hosp.

    Eye Dr contacted me in Jan 2013 advising my Aetna Insurance policy did not pay the bill during previous year.
    I contacted Insurance company and they said the Eye Dr billed incorrectly as an office visit (ilo ER visit).

    Eye Dr changed billing after 3 months and resubmitted - inuraqnce company denied again .
    I called back Insurance company and they changed their response when I spoke with a supervisor ... they said the global company I worked for
    changed their medical provider in Jan 2013 to another health insurance company and all bills needed to be paid by Dec 31st 2012. SO they werent going to pay.
    I advised the Eye Dr.

    Eye Dr threatening to ruin my good credit by sending to a collections company.

    Do I still owe this debt even though it would have been fully paid if the Eye Dr had correctly submitted the bill any tyime during the enitre year of 2012 ?

    Thanks

  2. #2
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,521

    Default Re: Can a Doctors Office Bill Me for a Claim They Failed to Properly Submit to Insura

    Is the eye doctor - NOT the hospital, the doctor - in your insurance network?

    Does your insurance policy expressly state that the doctor has sole responsibility for filing insurance claims?

    Those are real questions - not every doctor in any given network hospital is going to be in network, and some policies require the doctor to file the claims and some do not. The answer is different depending on the answers.

  3. #3
    Join Date
    Sep 2013
    Posts
    244

    Default Re: Can a Doctors Office Bill Me for a Claim They Failed to Properly Submit to Insura

    wow, this is the first instance of going to an ER for an eye problem actually have a very positive outcome (at least medically). but you were able to see an eye specialist - consider yourself very lucky. normal ER's are just not equipped to deal with most eye problems. they are rather a specialty organ.

  4. #4
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,521

    Default Re: Can a Doctors Office Bill Me for a Claim They Failed to Properly Submit to Insura

    Really? The very first? Ever? In any hospital?

    Got back up for that unbelievably ridiculous response?

  5. #5
    Join Date
    Sep 2013
    Posts
    244

    Default Re: Can a Doctors Office Bill Me for a Claim They Failed to Properly Submit to Insura

    Quote Quoting cbg
    View Post
    Really? The very first? Ever? In any hospital?

    Got back up for that unbelievably ridiculous response?

    i have the one about ... that's first in my book

    you have another?

    wait-you don't.

    moving on ...

  6. #6
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,521

    Default Re: Can a Doctors Office Bill Me for a Claim They Failed to Properly Submit to Insura

    My dear friend, I myself am proof that you are wrong. But you didn't want to hear that, did you?

  7. #7
    Join Date
    Sep 2013
    Posts
    6

    Red face Re: Can a Doctors Office Bill Me for a Claim They Failed to Properly Submit to Insura

    Thank You for youre response CBG. I submitted those questions to my previous healthcare insurance company today.

    I was previous VP for Western Union global - now work for Government - trying to automate, streamline and downsize every month (Conservative Values :-)

    I had a previous eye surgeries with doctors that went wrong and caused permanent eye damage (I plan to file a suit - and will post on another thread)

  8. #8
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,521

    Default Re: Can a Doctors Office Bill Me for a Claim They Failed to Properly Submit to Insura

    When you get the answers to those questions let me know and we'll go to the next step.

  9. #9
    Join Date
    Sep 2013
    Posts
    6

    Default Re: Can a Doctors Office Bill Me for a Claim They Failed to Properly Submit to Insura

    I called Insurance Company today - they said YES to both questions... Eye Dr is part of the Insurance Netwrk (Separate from Hosp), and is solely responsible for their billing for services.

    I posted my other medical claim un Medical Malpractice

    Thank You

  10. #10
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,521

    Default Re: Can a Doctors Office Bill Me for a Claim They Failed to Properly Submit to Insura

    Then you are most likely not responsible for the bill. However, you will need that verified by the insurance carrier. When you call them back, you will not be looking for Member Services or Customer Service or whatever is the name of the department at the other end of the phone number on your ID card. You will want to talk to their Provider Relations department, or whatever is the name of the department that administers the doctors' contracts.

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