Husband had emergency hand surgery in 2007 after cutting the tendon with a knife. Entered through the emergency room. Surgery performed in the emergency room. Insurrance covered hospital bill. went for follow ups with the surgeon. At a follow up appointment, husband complained that the stiches felt tight, so Dr. cut him open in the office and fixed it. I get a bill for $3500 later, insurrance won’t cover it because it was done in a non approved facility. I also receive a bill for $4900 for the original surgery. The Dr. office waited 2 years to submit and once they did the tax id number and address didn’t match what the insurrance company had on file so they did not pay.
How long after a procedure does a Dr. have to submit a clain to unsurrance? Also, since we went in for a routine follow up, should the office have contacted the insurrance to make sure the procedure would have been covered and should we have been informed that what we thaught was a minor thing was a major procedure. it was coded a s tendon surgery even though we thaught it was just a follow up. I now have over $8000 in bills and don’t know what to do.
Wow, what a bad situation. And the worst part is, it’s not in your favor.
This is a situation I have seen many times. People are under the assumption the insurance company is responsible for the debt when in fact the insurance company repays the claims the client/patient is responsible for. Ultimately, if the insurance company disallows a charge or procedure the patient is responsible for that debt.
I’m afraid the “not covered” argument isn’t going to be successful either. As the insurance policy holder you have a responsibility to know what your insurance will and won’t cover. If there is ever a question about coverage you should contact the insurance company first to verify coverage in order to avoid liability for the debt.
As I said before, insurance is there to relieve your financial responsibility and there is no obligation for a doctor to submit any insurance claim. Generally doctors will do it in an attempt to get paid rapidly but it is only a connivence to you and not their obligation.
My advice would be to contact the doctors office and explain the coding situation to them and see if they can change the charge for the service provided. If you received a bill for the original surgery and it was a covered expense, submit the claim to your insurance company for reimbursement. Contact your insurance company if you have any questions on how to submit the claim.
Please update me on your progress by posting updates here in the comments section of your question. I’m very interested in how this works out for you.