Insurance question?

Question

So i got a letter in the mail , they're charging me 246$ ( within 20 days ) for a biophysical profile when i went to the hospital. It says the procedure is not covered by my insurance. I mean they didnt tell me that at the moment so now im charged for it months later. My question is can they really do that? Should i call my insurance and see what they say or ?

Answer

I work for insurance. This isn't always the case but sometimes providers double bill their patients which is a big no-no. Always call your insurance and ask if they can adjust the claim (that's actually what I do, I'm an adjuster) and to look into your benefits and see if it was processed/denied correctly through them first before you pay the bill to the provider. Like I said, that's not always the case and sometimes only certain things are covered under your policy but it can't hurt to look into it before you pay the bill or set up a payment plan.

Answer

Yes they really can. I'm sure at some point you signed a paper stating you would pay for things that weren't covered. I get billed for ultrasounds months later because my insurance only covers one. Nothing you can do about it.

Answer

You can definitely try to fight it (I'd call the hospital first and then the insurance), but yeah, if the hospital bills the insurance and they say it's not a covered service they can totally do that.

Answer

Yes not everything is covered with your insurance, and they will bill you for services that aren't covered. For example I went to the ER in september. I just got a claim statement from my insurance yesterday  (still no bill)

Answer

Yes, it's your responsibility to see what is and is not covered, not theirs.

Answer

You can try to talk to the insurance or the hospital but unfortunately hospitals aren't going to go out of their way to check if a procedure is covered under your particular insurance. It's technically your responsibility. Now personally I think it's BS because it's easy enough to check the system but again hospitals and even many doctors don't want to be bothered. I've made it a priority to deny procedures until I call my insurance to confirm coverage (obviously not in the case of emergencies). Anything that doesn't sound routine I'll always double check and get pre authorized.

Answer

I would call the insurance and talk to them about it.

Insurance question?

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