Doctor never submitted my payment to insurance. Created a mess for me
Please help me understand, feel like I’m going crazy trying and failing to wrap my head around this….
On August 31st of this year my 9 month pregnant wife went to the OBGYN for a routine checkup. Suddenly there were some complications, I’ll spare the long details, but we were told to jump into the car and essentially head over to the other side of the state to the childrens hospital to help mitigate these potential risks.
Long story short 9/12 my daughter was born and she was mostly healthy. A one week stint in NICU and she came home and all is well.
The doctor who delivered the baby was great, her invoice person called us before the baby even came pestering us for payment though. It’s my first child so not sure if that’s typical or not. She wanted $5,500 . I gave her $4,000 and told her to submit the rest to my insurance provider and we can sort it from there. No problem…
Well here I am 5 or 6 weeks later and the $4,000 was never submitted to my insurance (United Health Care). That out of pocket payment of $4000 would have satisfied my Family Out of Pocket Maximum. I would’ve actually been about $2,000 over on my OOPM with that payment, thus looking for a refund.
We’ve called doctors office twice to tell them to submit to UHC and keep getting the run around.
In the meantime, I have about a dozen bills coming in weekly from other providers who want to be paid (and rightfully so). My frustration is that if the doctor who delivered the baby had submitted the $4000 payment to UHC, that my OOPM would have been satisfied and many of these bills coming from these providers would be 100% paid by UHC and I wouldn’t be responsible for them.
So now I’m trying to explain the situation to UHC who has been very little help. I would like UHC to call the doctor who appears to potentially be double dipping and get that $4000 claim submitted so that my OOPM is accurate. Then I’d like these invoices recalculated based on the accurate data. I believe this would result in my fiscal responsibility being far less.
For example my OOPM for family is $12,700 – of which I’ve already paid $10,100 (not including the $4,000). So had the baby doctor submitted I would be over my OOPM.
I guess the question I’m trying to ask is…Can I tell these providers they need to wait another 30 days or so because UHC is still processing claims and that my OOPM is satisfied from a payment back in September and the amount I personally owe will likely change? I am afraid they are going to destroy my credit if I don’t start paying, however I don’t want to just pay knowing I’ll be chasing money around looking for refunds…when I asked the agent from UHC she seemed to think my best course of action is to just pay all these invoices ($9,900 worth…LOL!) and chase down refunds. Just not possible nor am I interested in doing that.
I hope that’s not too confusing…Hopefully someone can help
