Uncovered Medical Bills

[Carrigon]

A few weeks ago, I went to an urgent care place when I was sick with the sinus and throat infection. They had advertised as taking my insurance. But when I got there, they said they don't take my plan, although they do accept plans from that company. They told me they would take my medicare and that medicare would pick it up. This turned out to not be true.

I called Medicare after finding out they denied the claim. And I was told that they will always deny the claim as long as I have my other insurance. The clinic won't bill my insurance, even though my insurance will pay this, because they refuse to accept that plan. So that leaves me stuck with the bill.

I knew I should have walked out of there when they said they didn't take my plan. But you know when you're really sick, and I mean really, really sick, and you have the brain fog and you don't really understand what's going on. That's what happened.

So now I'm stuck with this bill of a few hundred dollars and no idea how I'm going to pay it, other than tiny payments of like five dollars a month. I don't know what to do. I'm just very upset that it happened because I had the brain fog and I was so sick and really couldn't pay attention to anything that day.

 

[Jarod]

I know what you mean.

You might want to get some legal advice. Sometimes you can negotiate that bill, or just not pay it. If you are on SSDI I don't think they can garnish your wages if you don't pay. But there are laws that you have to stay within.

Maybe you could find a legal advice forum.

Probably need to get a link or document that shows their sources of info, so you know you are getting good advice.

good luck, that is a bummer

 

[Nielk]

Hi Carrigon,

I'm sorry to hear about your lack of insurance coverage for something that definitely should be covered.
Which is your primary insurance? Is it Medicare or the other plan? That is very important to know because depending which one is primary, that's the one who should pick it up first. I too have medicare and am on another plan through my husband from his workplace. My primary is Medicare. The other one is secondary. It has to do with the amount of workers at the place of my husband's employer. I also think every state has different rules. If Medicare is your primary (you can find out by calling them) then Medicare is obligated to pay the bill. It doesn't make a difference whether you have secondary coverage or not. If you other insurance is primary, they have to be billed first and if they deny it, you have to apply to Medicare and include this response of non-coverage. You should then take this bill and
send it to your secondary plan. Wait for their reply of non=coverage and then send it into Medicare together. Actually, this acute care place should be willing to do this for you but, you can do it yourself.
I hope this makes sense.
Good luck!

 

[Carrigon]

My primary is a medicare supplement. The clinic accepts plans from that company, but is refusing to accept this plan for some reason. And yet, urgent care is covered by my insurance. They would most likely pay this if the clinic would just bill them for it. All I can do is ask that an exception be made, see where I get. And I can send a copy of the bill to my primary insurance, too, and see if I get anywhere.

What drives me nuts is that this clinic will accept my plan in the next state, but they will not accept it in MY state. How crazy is that?

 

[SickOfSickness]

Sucks Yeah, try sending a copy yourself. You may have to get some form from the insurance company to fill out and include with the bill. Be prepared for them to question and deny it and having to resubmit again with more detail, or submit it to another department, or call and demand someone else in a different department or higher up. So keep copies and dates, and names and times of people you speak to.

 

[Carrigon]

I think my plan has out of network coverage for urgent care. And this was an urgent care visit. I know what to ask them now when I call. I remember seeing something about out of network coverage in my policy where I might only have to pay a small copay. I'm going to call them later and ask. I might have to send them the bill myself, but if they will pick up some or all of it, it's worth trying for.

 

[Nielk]

I think my plan has out of network coverage for urgent care. And this was an urgent care visit. I know what to ask them now when I call. I remember seeing something about out of network coverage in my policy where I might only have to pay a small copay. I'm going to call them later and ask. I might have to send them the bill myself, but if they will pick up some or all of it, it's worth trying for.

I hope it works out for you. I know how frustrating these situations are when dealing with insurance companies.
Good luck!

 

[Jarod]

One thing to try is call your insurance and find out what the deal is from them directly instead of taking the clinics word for it. Some times the insurance company can help straighten this out.

 

[Carrigon]

This may be very good news, I just don't want to count on it till I see them do it. I called my insurance and they said that even though this was out of network, they will pay the entire bill for me if this clinic bills them. So I called the clinic's billing dept and gave them the info and he said he's sending it right out now. So if my insurance picks it up, I should be fine. She didn't even say partial pay, she said the entire thing would be covered because it's urgent care. So let's hope it goes smoothly and I'll be okay.

 

[Carrigon]

My insurance paid it. I just got the news. I have a tiny fifteen dollar copay. I am so happy and so grateful. I was really worried about this. Won't be making the same mistake again. If I need to go anywhere it's the ER where I'm covered.