Another in/out network billing problem

[RMD3819]

Wife had an MRI done 2/18 (over a year ago) at an in network MRI center.

A few months in there was no insurance claim or bill so I started investigating. For the next ten months I went through a series of phone calls, emails, research with just about everyone except Santa Claus. A big black hole of wrong addresses, bad information, "checking into it". etc. I can't even get the claim submitted.

Finally in January 2019-almost one year later the claim is paid. Paid $452 out of a $3830 claim. Turns out they filed under the doc who is OON.

Called the MRI billing contractor. They told me they only bill for docs and not facilities.

Called the facility. They told me this is wrong and they should have billed with the facility tax ID and not the doc. They also stated the facility pays the doc directly so there should not be any bill from the doc at all. And I am not the only one with this problem. Another "working on it". Round and round.....

There is a 180 day window to file a revised claim from the January pay date. We are nearly three months in and nothing has been submitted. I really don't want to get stuck with the balance but that is what I see coming once the 180 days are up.

Any ideas?

 

[aikenhealth]

Sad reality is if you go to www.healthcarebluebook.com you will see the REAL "usual and customary" fair market cost of a MRI nationwide is only about $650 - less if it was just for a leg, knee or other isolated part of the body - THAT is the amount the medical providers SETTLE for - even though they bill $3830 - a real bait and switch - if you carry ACA or group coverage they stick it to you knowing you have a deductible you MUST meet out of pocket and always charge more than the usual and customary fee - and more that "cash up front / self pay" rates - even if you have a defined benefit plan which will reimburses your cash out of pocket - see it ll the time - a real shame. Just had a client negotiate a $12977 gall bladder bill down to $3560 - just by saying "self pay" - that was facility AND surgeon!

 

[Skohio]

If your calls to the insurance carrier are going in circles call your state department of insurance and file a complaint.

 

[RMD3819]

If your calls to the insurance carrier are going in circles call your state department of insurance and file a complaint.

The problem is not with the insurance carrier. The problem is with the MRI billing company.

Update-I received a bill in which they wrote off the remaining balance except for the $348 copay/coinsurance from the incorrectly filed OON claim.

This sounds great but the problem is I met OOP for 2018 so the MRI would be paid at 100% of the contract rate leaving me with $0 liability-if only they filed correctly as an in network provider.

Another round of phone calls and "checking into it". I am debating just paying the $348 but I am just not sure what to do.