I have a dilemma.
Currently I have a Clean TU, and a 30 Day late on EX and EQ from 02/2014.
I have two medical bill that my primairy insurance paid on, then my secondary paid on and the the rest was supposed to have been written off due to coordination of benefits. However the Hospital says I owe $4.99 on one bill and $2,300 on the other. I am disputing the amount due with the hospital and my secondary insurance has sent them documentation as well. Waiting for an update.
My dilemma is that the $4.99 bill will be going to collections soon if not paid. I could pay it, but am I setting the precident that I legitmatlly owe by paying it. I don't want a new collection when I am only a year and a half away from all clean reports, but I don't want to pay money I don't owe either.
You will need to send them a copy of your explanation of benefits that indicate you are not responsible for said charges. If you dont have this then you are likely on the hook for it.
@gdale6 wrote:
You will need to send them a copy of your explanation of benefits that indicate you are not responsible for said charges. If you dont have this then you are likely on the hook for it.
I already sent them my copy of the EOB and secondary sent them a copy as well. The EOB clearly states Patient Responsibility is $0, however they are still telling me I owe the balance.
One caveat to all this is that only primary insurance is regulated via contract.
No provider is obligated to bill secondary insurance unless it's Medicare (MSP 1-7) or Medicaid. If secondary commercial insurance billed, it's referred to as "courtesy billing"
Most providers will bill secondary because good luck collecting from the patient, but some may not.
If the hospital (or any provider) is not contracted with secondary, they can bill the difference between pt. responsibility and *usual and customary* charges. If they are contracted with both primary and secondary, they have to perform write off only if billing occurred.
If you submitted your own bill, they are not bound by it, unfortunately.
Did primary insurance do a claim crossover, manual billing or did you submit your own claim to secondary insurance?
Is secondary insurance contracted with the hospital and/or outside services?
Also, if claim was split in technical and professional components (radiology, gastroenterology and cardiology almost always do), one may get paid and the other one may not because same service would be split between two entities who may not have identical contracts
As an example, if you get a CT in a hospital, scan itself is technical component and will fall under hospital contract.
Reading the images may be done by an outside radiologist, that's professional component, and they may or may not be contracted.
So, as you can see, lots of variables in play 
In a nutshell...are both insurances contracted and how was secondary billed?
@Remedios wrote:One caveat to all this is that only primary insurance is regulated via contract.
No provider is obligated to bill secondary insurance unless it's Medicare (MSP 1-7) or Medicaid. If secondary commercial insurance billed, it's referred to as "courtesy billing"
Most providers will bill secondary because good luck collecting from the patient, but some may not.
If the hospital (or any provider) is not contracted with secondary, they can bill the difference between pt. responsibility and *usual and customary* charges. If they are contracted with both primary and secondary, they have to perform write off only if billing occurred.
If you submitted your own bill, they are not bound by it, unfortunately.
Did primary insurance do a claim crossover, manual billing or did you submit your own claim to secondary insurance?
Is secondary insurance contracted with the hospital and/or outside services?
Also, if claim was split in technical and professional components (radiology, gastroenterology and cardiology almost always do), one may get paid and the other one may not because same service would be split between two entities who may not have identical contracts
As an example, if you get a CT in a hospital, scan itself is technical component and will fall under hospital contract.
Reading the images may be done by an outside radiologist, that's professional component, and they may or may not be contracted.
So, as you can see, lots of variables in play
In a nutshell...are both insurances contracted and how was secondary billed?
Both Insruances are In Network for the Health System, one bill is Doctory Visit, the other is ER and both are billed by the Health System directly to both insurance companies.
I have never had this issue with them in the past, but this year it seems to be a mess. The issue seems to be that my primary insurance has a lower contracted cost, and secondary is only paying upto that lower cost. The Health System is trying to bill me for the difference even though it exceeds the contracted cost with my primary insurance.
@MakingProgress wrote:
@Remedios wrote:One caveat to all this is that only primary insurance is regulated via contract.
No provider is obligated to bill secondary insurance unless it's Medicare (MSP 1-7) or Medicaid. If secondary commercial insurance billed, it's referred to as "courtesy billing"
Most providers will bill secondary because good luck collecting from the patient, but some may not.
If the hospital (or any provider) is not contracted with secondary, they can bill the difference between pt. responsibility and *usual and customary* charges. If they are contracted with both primary and secondary, they have to perform write off only if billing occurred.
If you submitted your own bill, they are not bound by it, unfortunately.
Did primary insurance do a claim crossover, manual billing or did you submit your own claim to secondary insurance?
Is secondary insurance contracted with the hospital and/or outside services?
Also, if claim was split in technical and professional components (radiology, gastroenterology and cardiology almost always do), one may get paid and the other one may not because same service would be split between two entities who may not have identical contracts
As an example, if you get a CT in a hospital, scan itself is technical component and will fall under hospital contract.
Reading the images may be done by an outside radiologist, that's professional component, and they may or may not be contracted.
So, as you can see, lots of variables in play
In a nutshell...are both insurances contracted and how was secondary billed?
Both Insruances are In Network for the Health System, one bill is Doctory Visit, the other is ER and both are billed by the Health System directly to both insurance companies.
I have never had this issue with them in the past, but this year it seems to be a mess. The issue seems to be that my primary insurance has a lower contracted cost, and secondary is only paying upto that lower cost. The Health System is trying to bill me for the difference even though it exceeds the contracted cost with my primary insurance.
That should be a write off. If you have EOBs from both insurances, they can only bill up to what secondary shows as pt. responsibility (if any). Primary insurance rates are no longer in play, because they accepted payment and, by proxy, adjudication from primary insurance.
The only way they can bill you for the difference is if they refund entire payment by the secondary insurance, then bill you entire left over amount, which they certainly wont do.
I would get secondary insurance involved. Most of them will make a three way call and talk to hospital (or whomever) is billing you.
@MakingProgress wrote:I have a dilemma.
Currently I have a Clean TU, and a 30 Day late on EX and EQ from 02/2014.
I have two medical bill that my primairy insurance paid on, then my secondary paid on and the the rest was supposed to have been written off due to coordination of benefits. However the Hospital says I owe $4.99 on one bill and $2,300 on the other. I am disputing the amount due with the hospital and my secondary insurance has sent them documentation as well. Waiting for an update.
My dilemma is that the $4.99 bill will be going to collections soon if not paid. I could pay it, but am I setting the precident that I legitmatlly owe by paying it. I don't want a new collection when I am only a year and a half away from all clean reports, but I don't want to pay money I don't owe either.
Spent the morning on the phone with the hospital billing and my health insruance. I really didn't get anywhere, hospital says I owe, insurance says I don't.
I called the hospital and asked for a Patient Advocate, she transfered me to the Billing Manager at the Hospital instead of at the 3rd party service they use. The billing manager was able to take care of the $4.99 bill, and she got the other reduced to $388.30 simply by looking at the information available in their system. She also gave me her direct number and the direct number of a Billing Specialist at the Hospital in case I have anymore issues with the 3rd party billing department. She was not happy that they hadn't done exactly what she did, and told me there was no reason they couldn't/shouldn't have done that.
I will be having my secondary insurance call her directly to discuss the remaining balance. I am hopeful with that phone call everything can be settled.
After asking my health insurance to call the billing manager at the hospital I now owe $0 for both of the bills in question and don't have to worry about a new collections account.
