Practice/provider confirmed in network x3, but on billing network denies covering provider. Suspect this may be because the office moved and changed accepted insurances after treatment but before submitting my claim. Now in collections. Options?
I'm wondering if I should just suck it up and pay the bill of around $580.00 after how much time and energy this has taken, but on principle I'm trying to make insurance pay up. 34, 86004, I can afford to pay the bill if I must but I'm not currently employed and would prefer to keep the funds in savings.
Timeline:
January 2022
I tear my ACL I have insurance with EMI, through them (likely via search on their site but possibly via phone call) I find a provider in my town that's in network. I call the practice to confirm they're in network, along with providing my insurance card before getting treatment to confirm they're in network. Everything confirms they're IN NETWORK, I did a lot of legwork to make sure. Book an appointment to get my leg looked at, manual diagnosis + x rays
February 2022
The practice moves offices to a brand new, newly constructed location with new billing etc and, I think, makes changes to the name of the (big) orthopedic practice The practice submits its claims to EMI for my January treatment after this move
June 2022
I have gotten a new job and swapped to BCBS via my company knowing I'll need ACL surgery Go through the very long and grueling process of prepping, getting surgery, rehab, etc. Even with the best PPO BCBS offers my out of pocket cost is still $2700+ and a gigantic nuisance but at least they're not EMI.
November 2022
Start receiving bills through the practice for the xray appointment in January 2022 that should have been covered by EMI Call to argue that they were in network. Practice says EMI has declined twice for being out of network, now my responsibility. I have no way to prove they confirmed they accepted EMI since it was a phone call and them running my insurance card at the previous office location. Call EMI to argue with them, they say they don't have my doctor or practice in network even though they referred me to the doctor. As this was a phone call or search on their website, I don't have a record of them confirming they were in network. EMI & the practice send me back and forth between the two saying it's the other's problem. Ongoing issue with the practice where they can't find records of this because it was at their PREVIOUS LOCATION and regularly get my EMI coverage for Jan 2022 confused with BCBS Practice indicates via phone they'll resubmit and get the bill figured out
January/February 2023
Practice sends my bill to medical collections (BME) and my credit score plummets I dispute the bill on experian and transunion, they verify the bill I call the medical collections company who send me back to the practice who send me back to EMI Still in this battle – just got off the phone for about the tenth time with the practice's billing department promising to figure out what's going on
My current and only guess as to what happened is that when the practice moved, they stopped accepting EMI and so EMI claimed they were out of network, even though at the time of treatment they were in network. Is that possible? EMI insists they do not cover my doctor or practice, but again I found the doctor/surgeon himself DIRECTLY through EMI.
Will update as I hear back from the practice and the insurance, I have asked the practice to provide a list of insurance accepted by my doctor at time of treatment but apparently that's very hard to track down.
Do I just suck it up and pay? Any avenues I haven't tried yet? Thanks so much y'all for your time.
submitted by /u/scru
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