Who to call re: hospital/doctor billing issue

[asoctoberfalls]

I'm at my whit's end with the hospital and I don't know where to turn!

DS was hospitalized in May due to some concerns with chronic acid reflux and a laryngeal cleft that affects his swallowing.  A number of tests were requested by his GI and ENT doctors, one of which was a brain MRI to look for structural issues that could potentially be related to his swallowing and GI issues.  The MRI was normal as far as the symmetry issues the GI and ENT were looking for, but the person who read the MRI saw some spots he was concerned about and said we needed to follow up with peds neurology, which we did.  The Neurologist said that the guy who read the MRI must not have been familiar with MRIs in 2 year olds, because the abnormalities he noted were normal for a young child.  After observing DS's speech, motor skills, etc., the neurologist said he was fine and we didn't need to follow up.

When I got the EOB, it was rejected by my insurance because they coded the reason for the neurologist visit as "expressive language disorder."  I made a number of phone calls.

• Billing said that they could only bill what the doctor's office gave them, so I needed to take it up with the doctor.
  
• Doctor's office said their paperwork clearly states the reason for the visit is a follow up to an abnormal scan. Expressive language was #5 on a list of concerns discussed during the visit. They said to call patient advocates.
  
• Patient advocates said they don't help with billing issues... gave me the number for a supervisor in the billing department.
• Supervisor in billing says that she had a number of billers look at it, and none of them could come up with a diagnosis code other than "expressive language disorder." They said they submitted an appeal to see if my insurance company will cover it. (They won't. It says in black and white in my book that language disorders are not covered under our health insurance).

I have no clue who to call next.  Everyone is passing the buck and saying it is someone else's responsibility.  The bill is over $500 for a 20 minute visit, and I shouldn't have to pay it... but at the same time, I'm concerned they'll send me to collections.  We're building a house (closing in a few months) and I don't want to mess up my credit.

Anyone have any ideas?  Stories?  Hair pats?

[zarapipe]

So the doctors office is the one who submitted the claim? If so I would go back there and ask them to resubmit for one of the other 4 reasons for the visit.

[everafter07]

Absolutely call again or go to the doctors office and tell them they need to find a code pertaining to your visit and issue that your insurance will cover. If they say no, ask to speak with the doctor directly, or the office manager and explain the situation. I'm sorry you're getting the runaround.

[asoctoberfalls]

I did call the doctor's office again and left a message with the doctor's NP/PA/whateversheis. Doctor's office says they can't resubmit...they said once it's in billing, it's out of their control and there's nothing they can do about it. Billing says that they can't ask the doctor to change the code. I'm so annoyed...someone is obviously punting who shouldn't be.

Good call on asking the office manager, everafter07. I didn't even think of that!

[everafter07]

I hope you get it straightened out. That's total BS. It just takes a phone call from the office to billing to say STOP PROCESSING that claim, we're going to resubmit. Unreal how difficult docs/insurance can be.

[asoctoberfalls]

The actual doctor called me back today. Apparently he did submit it as an expressive language delay. He said there was no code for a follow up to an abnormal scan.

He's going to work with DS's other doctors to try to find a code insurance will accept. It's bs that he has to waste his time doing that. Insurance companies suck!