does anyone know anything about health insurance billing?

[zarapipe]

BC I'm about to lose my shit on BCBSNC and my shitty in town hospital. I have spent countless hours on the phone with them for multiple billing issues, including depositing a check of mine in a different account, not crediting my account correctly, not receiving BCBSNC payments even through BCBS shows it deposited, etc. I have been fighting with a bill from May 2013 since January because they called and offered me 50% off it I paid off my payment plan in full. I did and they never gave me the 50% off so I still have a balance. THEN last week I got another bill from the same date of service that was $500 more than my last bill (That I am refusing to pay because it was to be paid off by them when they offered to 50% off). Apparently they submitted an adjustment 2 years and 2 months after the date of service! I'm looking online and I see that there was this new rule in place that says there is a two year time limit on filing corrected claims. So how could they submit an adjustment?

[perkyderky]

I'm sorry, i can't help in any way. But, I do find BCBSNC to be pretty horrible as far as their CS is concerned. Last June I received a check in the mail for a pretty substantial sum. In the explanation it had a 1 word name on it, and i had no idea what that was. Neither did CS when I called them. Needless to say, in January of this year, I finally received the bill for that amount. 6 months later--??
And it's CRAZY to me to think they have up to 2 years to make changes? WTF?

I haven't deposited 2 checks I've recently received from my local hospital yet, simply because I'm more or less figuring that it's too good to be true and that I will receive a new BCBSNC bill any day now...

Good luck. Fight the fight!

[niq]

No.

And I don't mean "nobody on this board". I mean "no one on this planet".

I'm sorry.

[ssmjlm]

Take copious notes. Dates, times, who you talk to, what you discussed. Get a case# if need be.

[swimmette]

I am shocked that they said 2 years, because Medicare only gives 180 days to appeal and 365 days to submit an unpaid claim.  Most insurances either follow Medicare or have a much shorter time frame.

I would ask that they give you a copy of the original EOP (explanation of payment) showing what was billed and paid (or denied), the appeal or adjustment that was sent, and the EOP that was received as a result of the resubmitted claim.  By law they must keep insurance payments and letters on file, so they should be able to send this to you.

[MadamePresident]

We are still fighting with insurance to cover the bill from Chase's birth a year ago.

[indylady]

Jul 27, 2015 12:00:19 GMT -5 ssmjlm said:

Take copious notes. Dates, times, who you talk to, what you discussed. Get a case# if need be.

And don't be afraid to ask for a supervisor. Be nice but firm that you need a resolution in writing by a certain date (like the end of the week, for example).

[sent]

Your state has an insurance commissioner. Don't be afraid to call them and see if they can offer any help. They can sometimes put pressure on insurance companies when insurance companies are being incredibly horrible and not following the insurance laws to operate in your state. But as far as the hospital billing being incompetent, I don't know if they can help there.

[melsamoony]

Get the original explanation of benefits, contact a medical auditor, and if necessary contact your state's bureau of insurance. On the hospital's account just keep escalating until you get to the top. Submit a written complaint documenting all the problems to the billing manager.

I hope you get some resolution.