I had a minor outpatient surgery at a local hospital a couple of months ago. When I later received the EOB from the insurance company, it said they denied the claim.
It stated the following regarding the denied claim: “You do not have to pay this. Your plan requires precertification for this service, for the place of service in which the procedure was performed. We have no record of precertification.”
In other words, the provider failed to get the proper pre-certification beforehand. Since it said “You do not have to pay this” on the EOB, I didn’t really sweat it.
Fast forward to a few days ago, the doctor’s office calls me. They claim the insurance company initially told them no pre-certification was required, and they were dumbfounded why the claim ended up being denied for failure to get pre-certification.
The doctor’s office wants me to call and complain to the insurance company. I basically told them I didn’t want to get involved, since the dispute was between them and the insurer. They then responded by threatening to bill me for the procedure, and hung up on me. (real professional, I know.)
My question is, what recourse do I have if the insurance refuses to pay, and the doctor’s office then sends me the bill? Call a lawyer? It says on the EOB “You do not have to pay this” so I am pretty confident that I am not on the hook for the bill. But I don’t know if this would be enough to prevent the doctor’s office from eventually sending me to collections over the unpaid bill.
Any advice on how to handle this would be appreciated. Thanks!
submitted by /u/Significant_Data_576
[link] [comments]I had a minor outpatient surgery at a local hospital a couple of months ago. When I later received the EOB from the insurance company, it said they denied the claim. It stated the following regarding the denied claim: “You do not have to pay this. Your plan requires precertification for this service, for the place of service in which the procedure was performed. We have no record of precertification.” In other words, the provider failed to get the proper pre-certification beforehand. Since it said “You do not have to pay this” on the EOB, I didn’t really sweat it. Fast forward to a few days ago, the doctor’s office calls me. They claim the insurance company initially told them no pre-certification was required, and they were dumbfounded why the claim ended up being denied for failure to get pre-certification. The doctor’s office wants me to call and complain to the insurance company. I basically told them I didn’t want to get involved, since the dispute was between them and the insurer. They then responded by threatening to bill me for the procedure, and hung up on me. (real professional, I know.) My question is, what recourse do I have if the insurance refuses to pay, and the doctor’s office then sends me the bill? Call a lawyer? It says on the EOB “You do not have to pay this” so I am pretty confident that I am not on the hook for the bill. But I don’t know if this would be enough to prevent the doctor’s office from eventually sending me to collections over the unpaid bill. Any advice on how to handle this would be appreciated. Thanks! submitted by /u/Significant_Data_576 [link] [comments]Read Morer/HealthInsurance