why our healthcare system sucks part 2,593

so one of the doctors that saw me during one of my hospital visits last august, filed a claim with my health insurance. sounds ok to me so far. there was some information that was left off of the claim form, such as the date of service. this claim was denied and sent back to the provider to correct the omissions. the provider took about two months to address the issue and then sent me a bill for the total amount . i responded with this letter .. ..

after i sent that letter, i received another bill which said that i owed the total amount. at this point i wrote them back stating that my explanation of benefits indicated that the current patient responsibility was $0.00 and that since they were a preferred provider in my ppo network, no payment was due until the eob said so.

then they decided to send me a threatning letter saying that if i did not pay the current amount that they would send the balance to a collection agency. at this point i called the attorney generals office and asked for some assistance. they informed me that i was not responsible for the balance since it was due to their omission. i wrote them back and informed them of this.

so last week i got a new eob in the mail regarding this claim and it was again denied due to a lack of information from the provider. once i got this letter i decieded to call the insurance company to see if i could give them the information that they needed. .again i was told that i could not. .. so i asked the customer service rep if she could call them and ask them directly for whatever information it is that they need to finally process the claim. so we will see what happens now.

i could be wrong but this ONE claim has taken at least three hours of my time, i am guessing at least three hours of time from both my insurance company and the provider. .. for what. .to get back to exactly the same place that we started at. at some point isn't it cheaper to write these amounts off and not spend so much time and energy and effort trying to collect. the other reason i think that these providers are so nasty about trying to get me to pay them is that if i pay them- i have to pay the entire bill of $475. .but odds are my insurance will only pay them $200 or so. . but if i pay the 475 and submit it to my insurnace they will pay me back the full 475. .

it makes me sick