Problems with medical bills

D

dforth79

Guest
Jurisdiction
Utah
My wife recently received an Outpatient back procedure that was around an 1 hr long, it was for injections in her back. We had to go to the hospital because they had to do some slight sedation. We received the CPT and diagnostic code we then called the insurance and it did not have to be preapproved. The Hospital and the Doctor who ordered it did as well. When the Hospital billed the insurance they used different codes and somehow a procedure that is usually billed around $4000 was billed at above $40,000, and the insurance is saying it has to be preapproved because they are using different codes. I have called the hospital and the insurance and have been given the run around. I am not sure what my rights are in this type of situation
 
Have you called the Dr? The Doctor would probably be the one to correct the codes and have it resubmitted. If you can't get it resolved through the Dr. go to the Hospital billing office. It's harder to be ignored in person.
 
And you'll keep getting the run around while they send you to collections and trash your credit, maybe even sue you.

This is the kind of maelstrom you don't get out of without the help of an attorney.

At least not with $40,000 at stake.
 
Have you called the Dr? The Doctor would probably be the one to correct the codes and have it resubmitted. If you can't get it resolved through the Dr. go to the Hospital billing office. It's harder to be ignored in person.

I did call the dr office and they said that from the images that was sent to them this was the proper coding, but that there was no way the Hospital should be charging that much for this type of procedure. I have talked to an attorney if needed he will help, but I am not sure what to think, we did everything that you are suppose to. I cannot believe that a different procedure was done that they did not check for preapproval or tell us so we could check before they did it.
 
I did call the dr office and they said that from the images that was sent to them this was the proper coding, but that there was no way the Hospital should be charging that much for this type of procedure. I have talked to an attorney if needed he will help, but I am not sure what to think, we did everything that you are suppose to. I cannot believe that a different procedure was done that they did not check for preapproval or tell us so we could check before they did it.


It can't hurt to do as "adjusterjack" suggested, visit the facility billing office in person.
Ask for an explanation and pose this question, "Is it possible that $40K was charged in error, thereby causing a $4K charge to morph into a $40K charge?"
 
The medical records will also have the type of procedure done, as well as the scope. Get those and take them to the attorney/physician's office/medical billing.

Another thought: Have you gone through the insurance's appeal process?
 
The medical records will also have the type of procedure done, as well as the scope. Get those and take them to the attorney/physician's office/medical billing.

Another thought: Have you gone through the insurance's appeal process?

I have started that as well, they seem to be as surprised as I am about the size of the bill
 
Slow your roll on running to an attorney. 9 times in 10 that slows down the process. get the actual records and speak with whomever sent out the codes to the IC. 99% of the time, it is just a clerical error. If the more expensive procedure had to be performed for some reason, appeal the pre-authorization requirement with the IC. If the doctor won't fix the code and the more expensive procedure wasn't performed, file an appeal of the bill with the IC using whatever proves they outline.
 
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