This past November, my wife had to see a doctor at our local Urgent Care. Unfortunately, when the bill showed up the claim had been denied. The reason? Out of network. The problem? It wasn’t out of network! It’s supposed to be a $20 co-pay with the rest going to insurance. So… I called the Urgent Care billing office on December 15th. They confirmed that it should’ve been covered, and promised to re-submit the claim. Fast forward to this week…
We just got another bill from Urgent Care. Same deal — they want the full balance. This time, however, it seems that our insurance company decided to split the difference and apply it to our deductible instead of flat-out denying the claim, or paying it like they’re supposed to. When I called the Urgent Care billing office, they weren’t sure what went wrong, but promised to re-file the claim. Again.
Instead of waiting another month to see if the problem was still there, I decided to call Blue Cross & Blue Shield directly. After a bit of noodling around, the CSR seems to have figured out the problem. It seems that the doctor filed the claim using his own taxpayer identification number (TIN) instead of the TIN for the Urgent Care clinic. She further stated that whenever this happens, they have to go in and override it by hand. Whatever.
The bottom line here is that a less persistent person would’ve assumed that the insurance company knew what they were talking about, or perhaps lost track of the situation entirely and ended up paying the bill. Always double-check your medical bills. And always appeal your health insurance denials.