Balance Billing in TN: wht can we do?

Hi all,

I’m not really sure where to get help for the current situation my husband and I are facing. If anyone has insights or suggestions, it would be greatly appreciated. Also, if there’s a better sub for this, please let me know.

My husband visited an in-network Emergency Room in October of last year in Tennessee. It was determined that he was suffering from appendicitis and was transferred to the ER’s hospital for surgery. Our insurance provider, Humana, paid the ER doc at an in-network rate despite the fact he was out-of-network as a provider.

About a month later, my husband received a text message from “Sound Physicians Emergency Med of Greater TOWN NAME.” It looked strange so he did not open it. We then received a statement by mail from this same company. Upon reviewing it, I realized the company that contracted the ER doc at the hospital was balance billing us for the remaining $1,417.76 he was “owed” that our insurance did not cover.

Keep in mind this guy has been paid an in-network rate. Apparently, he does not accept private insurance and only accepts Medicare. This was never communicated to us during our visit. We also saw the guy about 5 minutes (I realize this probably doesn’t matter but it pisses me off). Humana also claimed he was double billing for a couple of CPT codes. I tried to get in touch with the Sound Physicians company to explain the matter and they said we still owe the $1,417.76. I then reached to Humana. They were not much help but said I could file a grievance. I did and it was denied. I’ve emailed and called the hospital. Someone always says they’ll call me back and they never do.

Now, Sound Physicians is saying they will send us to collections. I want to make sure I exhaust all avenues before I pay them.

submitted by /u/caballos0204
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Hi all, I’m not really sure where to get help for the current situation my husband and I are facing. If anyone has insights or suggestions, it would be greatly appreciated. Also, if there’s a better sub for this, please let me know. My husband visited an in-network Emergency Room in October of last year in Tennessee. It was determined that he was suffering from appendicitis and was transferred to the ER’s hospital for surgery. Our insurance provider, Humana, paid the ER doc at an in-network rate despite the fact he was out-of-network as a provider. About a month later, my husband received a text message from “Sound Physicians Emergency Med of Greater TOWN NAME.” It looked strange so he did not open it. We then received a statement by mail from this same company. Upon reviewing it, I realized the company that contracted the ER doc at the hospital was balance billing us for the remaining $1,417.76 he was “owed” that our insurance did not cover. Keep in mind this guy has been paid an in-network rate. Apparently, he does not accept private insurance and only accepts Medicare. This was never communicated to us during our visit. We also saw the guy about 5 minutes (I realize this probably doesn’t matter but it pisses me off). Humana also claimed he was double billing for a couple of CPT codes. I tried to get in touch with the Sound Physicians company to explain the matter and they said we still owe the $1,417.76. I then reached to Humana. They were not much help but said I could file a grievance. I did and it was denied. I’ve emailed and called the hospital. Someone always says they’ll call me back and they never do. Now, Sound Physicians is saying they will send us to collections. I want to make sure I exhaust all avenues before I pay them.
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