Hospital sent a bill to collections that should've been covered by insurance

So I work in a doctor's office that sends claims to insurance companies.

  1. If you have access to your insurance company's website, log in and check for the DOS (Date of service) that the doctor's office is calling about. See if you can find any information.

  2. If that doesn't work, call your insurance company (the number should be on the back of your card) and call the claims department. Ask about that DOS. If they ask for a billed amount, tell them your story and see if they can help you out.

See if it was paid or denied. If it was not paid find out why. Also, ask them what the eligible amount for the procedures the doctor's office visit performed. See if you can get this in writing.

Get the insurance to fax or mail you the EOB (explanation of benefits) of the denied claim. (although your insurance company should have sent you this). Finally, see when your insurance company received your claim. This will give you an indication of how long it took your doctor's office to send it to your insurance company. If it was late, you could complain to the doctor's office or the manager.

  1. You could call the doctor's office back and ask if they're willing to call the collection's company to take back your claim if the doctor's office is willing to take the eligible amount. If not you could try and negotiate with the collection company.

It's uncommon for doctor's offices to not get paid for 3-6 months, but it happens because of miscommunication of what insurance the patient actually has. Also, there are really bad billers that take their time to send the claims. I hope some of this helps.

/r/personalfinance Thread