Help Needed -- Insurance Switch Mid-Pregnancy, Double Billed

Oct 15, 2016

  1. doublebill

    doublebill New Member

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    Hey everyone!

    I'm trying to get some advice on what to do about something with my health insurance. My company provides my health insurance and we were on a BCBS PPO plan up until October 1st, when we switched over to a UHC PPO. I'm currently pregnant and have been since April (due in January).

    BCBS paid their responsible amount for all of my outstanding prenatal care costs--everything on the online health portal for my OB's office showed them as paid in full once I paid off the remaining amount that I was responsible for. But now that my insurance has changed, it looks like my OB's office is suddenly attempting to re-bill all of my old appointments... all the way back to my first appointment in June... to the new health insurance company.

    I'm not sure why they would do this, but is this normal? I'm guessing the answer is no, but I've never switched health insurance companies in the middle of a pregnancy before so I don't know what to make of the whole thing... I don't have any physical copies that show the old bills as being previously paid off but they definitely were and I'm hoping my OB's office hasn't somehow lost record of that :err:
  2. kgmom219

    kgmom219 What's Next?

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    1. Get copies of the EOB's from BCBS
    2. Get a statement from the OB
    3. Go to HR and ask them to contact their broker and/or UHC rep, supplying the documentation from #1 and #2.

    The issue is that the contracts between the OB and the carrier may be different. Some do "as you go" for all 9 months. Some contracts do 1 bill after the 6 week checkup. And if you went HMO to PPO, it gets even more confusing.

    Congrats on your pregnancy!
    kgmom219, Oct 15, 2016
  3. rcduggan

    rcduggan Super Genius

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    hi there and congrats on you pregnancy!

    this is NOT normal and could be one of two things: an error or fraud.

    there's a a fewthings here and i will start by picking them out and then offer you a solution as the poster above me. i can handle it for you but i have to charge for my time, the choice is yours.

    1) the PPACA implemented a number of benefits to be covered under preventive care and women's care including but not limited to pre/postnatal care (meaning costs are covered by the insurance company). it is assumed your plan was not grandfathered at BCBS.

    2) assuming you had a newer BCBS plan you would have not made any payments but all records from both parties (carrier EOBs or explanation of benefits & provider billing charges/statement/ledger). as disclosed by previous poster you can retrieve your EOBs from the insurance company and the billing charges from the provider.

    3) in the times of the PPACA it is not uncommon mistakes are made but i dont know that i would call this a mistake, rather an intentional double billing, which would go un-noticed. technically speaking you didn't pay those prenatal visits. the OB's office may not be as out-standing as one would think and is purposely trying to get paid twice. i could be wrong though.

    if i were you, i'd go to the billing person in the OB office, point out the newly found information, and then look them in the eye and ask why they're doing what they're doing. good luck!

    i'd love to hear more about this in the future.
    rcduggan, Oct 15, 2016
  4. djs

    djs Super Moderator Moderator

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    Are you sure they billed the new carrier? Or did they just provide a history so they know what was paid already?

    For instance, if you had an out of pocket / deductible amount, they may have wanted to see that this part is covered already so they can pay their share correctly moving forward.

    Ask the office what is up.

    djs, Oct 16, 2016
  5. junkman

    junkman Guru

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    Many times the new carrier doesn't get correct data about deductibles and out of pocket that has already been met. You just need to get them that info. You can likely do it yourself by calling the prior carrier, asking for your last EOB ald sending it to the new carrier.

    Alternatively, just get in touch with the group agent and make him earn his keep. Figure the guy is making at least $20/head for every member enrolled. He should be willing to take care of all of the little problems that come up. If not, there are plenty here competent enough to replace him.
    junkman, Nov 3, 2016