What should we do?

minigreenhouseFebruary 24, 2006

My daughter had a rehab bill of $250 which should be covered by the insurance; however due to the rehab center staff goofed, i.e. he did not get precertification (he actually tried to get precertification but he called the wrong insurance co. - this insurance co. did not require precertification.)

In short, the rehab center wants us to pay for the bill because according to the rehab, it is our responsibility to get the precertification. We have appealed. The insurance came back to us and said it is the rehab's responsibility to get the precertification not the patient.

Now, the rehab threatens to send our bill to the collection agency if we do not pay.

What should we do? Is there any agency will assist us on this matter? We have spent so much time on appeal and phone calls on this matter. It is very stressful and the worst of all is that we are the only party that will get hurt on our credit score.

Any input would be greatly appreciated.

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first, pay the bill, then you should appeal it again to your insurance. the insurance company may well pay you back for it if you raise enough stink about it. if they absolutely refuse to pay the bill, then at least you have taken care of it and it does not go to collections.

    Bookmark   February 24, 2006 at 10:18AM
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Try documenting your fight with letters. Get something in writing from your insurance co that says it's the billing co's responsibility. Then send a copy of that letter to the rehab. If you at least document this it helps in the long run.

You might have to pay it to stop this place, but I wonder if you try talking to the physicians rather than the billing clerks if you might get somewhere. Or, I mean, WRITING to them, talking does no good whatsoever.

I once got socked with a huge bill and the fight went on for months because the billing clerk had billed the wrong insurance co and argued with me incessantly that I was wrong. Even when the insurance co showed her that I had coverage under the correct co, she tried to make it out that I was still responsible for paying the bill and to fight it with my insurance co. I wrote a letter to the doctor and never heard another word from them again.

    Bookmark   February 24, 2006 at 2:52PM
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You might have to pay it to stop this place, but I wonder if you try talking to the physicians rather than the billing clerks if you might get somewhere. Or, I mean, WRITING to them, talking does no good whatsoever.

You were lucky that it worked for you. Most of the physicians I have known in a clinic setting (about all there is around here anymore) take a hands-off approach to the money part of it. If a letter even reached them (odds are good it would be opened by someone else and diverted), there likely would not be much they could do.

But, hey, it's a 39 cent stamp. Give it a shot.

    Bookmark   February 25, 2006 at 9:48AM
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You could try talking to the office manager. I had to do that when I got turned into a collection agency for an unpaid bill that the insurance would have paid had they been billed. I hadn't been billed either. Seems as though this particular office had been through several billing companies and no one knew what the other had or hadn't done. I spoke with the office manager who immediately removed the account from collections, got all my insurance information and billed them. Never heard from them again. It was paid by my insurance two years after date of service. And BTW, after I no longer had that insurance.

    Bookmark   February 27, 2006 at 11:53AM
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If they don't listen to reason at the insurance company, you should call a reporter at your local paper who does investigative journalism. It might change the insurance company's mind real soon.

It also doesn't hurt to contact your elected representative's office. For $250, the insurance company may decide it's not worth the hassle. Good luck.

    Bookmark   February 28, 2006 at 1:45AM
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After spending a lot of time working in precertification and medical billing, we always tried to get precertification as A COURTESY to the patient, but ultimately it was THE PATIENT'S responsibility to make sure that none was required or it indeed was precertified.

With the different group policies and companies, it is virtually impossible for the physicians' office to stay informed about all patients' insurance coverages. It is important for the patients to stay in control of their own health care situation.

I would definitely pay the bill, or at the very least set up some sort of payment plan with the physician and STICK TO IT while you work through the insurance coverage issues. $250 isn't worth doing in your credit.

    Bookmark   February 28, 2006 at 7:36AM
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pay it with a credit card, then put it in contest.

    Bookmark   March 4, 2006 at 5:02AM
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