Insurance company denied to cover a bill after I made an OOP payment to the service provider

news

I went for a surgery in October last year (2019). The anesthesia service billed about $3500. In January this year (2020), I received the EOB from Bluecross showing that the bill is COVERED (note that I am not in network). However, up to June, neither myself nor my provider received the check for unknown reason. Then, my service billing office sent me the delinquency notification. I was in a hurry moving to another state at that time, and I didn’t want to be bugged by delinquency records and therefore I paid the bill to the provider OOP, thinking that the only thing remaining is waiting for the check from Bluecross.

After knowing I have paid OOP, Bluecross cheated me saying that in this case I have to submit a subscriber claim. I followed this instruction but then my claim got denied. I called them several times but they just gave BS, like we are sending to local office for pricing, we are sorting this out, it would take 45 biz days, etc. Couple of weeks ago I got another denial. It has been 4 months and they still gave me hard time. The point is, they have approved this coverage in January (both the billing office and I received this message. I still keep the EOB). Can they change their mind after knowing I paid OOP? Is there anything I can do, like finding an attorney? Thanks in advance for your reply.

submitted by /u/JimmyKOF98
[link] [comments]
I went for a surgery in October last year (2019). The anesthesia service billed about $3500. In January this year (2020), I received the EOB from Bluecross showing that the bill is COVERED (note that I am not in network). However, up to June, neither myself nor my provider received the check for unknown reason. Then, my service billing office sent me the delinquency notification. I was in a hurry moving to another state at that time, and I didn’t want to be bugged by delinquency records and therefore I paid the bill to the provider OOP, thinking that the only thing remaining is waiting for the check from Bluecross. After knowing I have paid OOP, Bluecross cheated me saying that in this case I have to submit a subscriber claim. I followed this instruction but then my claim got denied. I called them several times but they just gave BS, like we are sending to local office for pricing, we are sorting this out, it would take 45 biz days, etc. Couple of weeks ago I got another denial. It has been 4 months and they still gave me hard time. The point is, they have approved this coverage in January (both the billing office and I received this message. I still keep the EOB). Can they change their mind after knowing I paid OOP? Is there anything I can do, like finding an attorney? Thanks in advance for your reply.
submitted by /u/JimmyKOF98 [link] [comments]Read Morer/HealthInsurance

Leave a Reply

Your email address will not be published. Required fields are marked *