So I went to get my annual health check up. These are supposed to be covered 100% by insurance as they are preventative, per the ACA. Just trying to do the right thing…
Anyway, of course, still got bills for blood work. Maybe there was some blood work that wasn’t considered “preventative,” that’s BS of course, but that’s not really my question.
Here’s the rub, in the EOB for this bill, it explicitly states:
“WE’VE NOTIFIED YOUR PROVIDER THAT WE CANNOT PAY FOR THIS SERVICE. YOU ARE NOT RESPONSIBILE FOR ANY BALANCE ON THIS SERVICE UNLESS YOUR PROVIDER TOLD YOU BEFORE PERFORMING THE SERVICE THAT IT WAS NOT COVERED.”
The provider, of course, did not tell me that certain procedures would not be covered.
I have been calling and arguing this point since January with the provider, they claim that their EOB copy doesn’t state what mine does, but told me that if I provided them a copy of my EOB, they would honor it and cancel out the charge.
To send them this EOB, it had to be via mail to a special mailbox, from the insurance company directly. I couldn’t just email them.
Now, after hours of work, they have the EOB with the above language, but they still insist that I owe them.
This appears to be a shakedown to wear me down into paying for something that I do not owe. They have not provided any evidence that I was aware that certain charges were not covered. I can only imagine they might argue that I signed some document beforehand agreeing to pay uncovered charges. I don’t believe I did, and they haven’t established that I did.
Even so, a blanket waiver like this feels illegalish, as any provider can then bill anything they wanted to the patient for any reason.
What is going on here? Is this a scam? Incompetence? They are now threatening collections for me. What is my legal recourse?
submitted by /u/TheLianeonProject
[link] [comments]So I went to get my annual health check up. These are supposed to be covered 100% by insurance as they are preventative, per the ACA. Just trying to do the right thing… Anyway, of course, still got bills for blood work. Maybe there was some blood work that wasn’t considered “preventative,” that’s BS of course, but that’s not really my question. Here’s the rub, in the EOB for this bill, it explicitly states: “WE’VE NOTIFIED YOUR PROVIDER THAT WE CANNOT PAY FOR THIS SERVICE. YOU ARE NOT RESPONSIBILE FOR ANY BALANCE ON THIS SERVICE UNLESS YOUR PROVIDER TOLD YOU BEFORE PERFORMING THE SERVICE THAT IT WAS NOT COVERED.” The provider, of course, did not tell me that certain procedures would not be covered. I have been calling and arguing this point since January with the provider, they claim that their EOB copy doesn’t state what mine does, but told me that if I provided them a copy of my EOB, they would honor it and cancel out the charge. To send them this EOB, it had to be via mail to a special mailbox, from the insurance company directly. I couldn’t just email them. Now, after hours of work, they have the EOB with the above language, but they still insist that I owe them. This appears to be a shakedown to wear me down into paying for something that I do not owe. They have not provided any evidence that I was aware that certain charges were not covered. I can only imagine they might argue that I signed some document beforehand agreeing to pay uncovered charges. I don’t believe I did, and they haven’t established that I did. Even so, a blanket waiver like this feels illegalish, as any provider can then bill anything they wanted to the patient for any reason. What is going on here? Is this a scam? Incompetence? They are now threatening collections for me. What is my legal recourse? submitted by /u/TheLianeonProject [link] [comments]Read Morer/HealthInsurance