Need opinions from anyone that works or is an expert with healthcare (1 Viewer)

[msudaisy26]

I have been married for 8 years and my husband and I have always had our own health insurance through our employer's. So we have dual coverage, his insurance is  primary for him and our daughter, and my insurance is secondary for them and it is the opposite for me. In those last 8 years we have had 23 bills where various doctors/dentists bill the wrong insurance as primary and secondary and what happens is both insurances deny the claim and then we get a massive bill and have to take the time to work it out ourselves. At first we thought it was just an honest mistake, but now we are having doctors and dentists that we see regularly do it almost every time we visit. Our dentist has sent us 4 bills for regular check ups and x-rays this year despite my husband and I each going in there to complain after the 1st visit. Is this a scam or are we just that unlucky? Is there any legal action? My doctor has sent a bill to collections despite 4 or 5 calls to her office explaining that they incorrectly billed the insurance companies and that is why it is being rejected.

 

[fred_1_15301]

I have been married for 8 years and my husband and I have always had our own health insurance through our employer's. So we have dual coverage, his insurance is  primary for him and our daughter, and my insurance is secondary for them and it is the opposite for me. In those last 8 years we have had 23 bills where various doctors/dentists bill the wrong insurance as primary and secondary and what happens is both insurances deny the claim and then we get a massive bill and have to take the time to work it out ourselves. At first we thought it was just an honest mistake, but now we are having doctors and dentists that we see regularly do it almost every time we visit. Our dentist has sent us 4 bills for regular check ups and x-rays this year despite my husband and I each going in there to complain after the 1st visit. Is this a scam or are we just that unlucky? Is there any legal action? My doctor has sent a bill to collections despite 4 or 5 calls to her office explaining that they incorrectly billed the insurance companies and that is why it is being rejected.

It seems like these specific practices are just clueless.  Can't you find new providers?

 

[RokNRole]

What makes one an expert on healthcare?

 

[quickhands]

Stop talking to the office contact the billers

 

[msudaisy26]

It seems like these specific practices are just clueless.  Can't you find new providers?

We are looking for a new dentist, we just moved last year and this was a new dentist. This is only the 2nd time this has happened with my doctor. The part that bothers me is they continue to bill my husband's insurance 1st despite my calls and visits to tell them to bill my insurance as primary. The other incidents are first time things, when I had our baby the hospital billed it wrong, when my husband had knee surgery the doctor and surgeon billed it wrong. It is to the point when we go to any doctor we tell them who to bill as primary and they just do it wrong anyways. 

 

[NutterButter]

Did you pay family premiums for both plans?   I didn't realize people did this.   Is this approach advantageous?  

 

[msudaisy26]

Stop talking to the office contact the billers

They are usually  the same people for us. 

 

[msudaisy26]

Did you pay family premiums for both plans?   I didn't realize people did this.   Is this approach advantageous?  

We do for my insurance, my husband's is all the same whether you are single or have a family with 8 kids. We have never looked to see how much we save with the dual coverage vs. just having family premium on his and not mine. We rarely pay copays though. 

 

[quickhands]

They shouldnt be.   When i have issues with clients i call the drs billers.  They known the doctors $$$.   If he has office staff doing it id be surprised unless its a dr. group.   If its office staff make an appointment and sit down with them.

 

[kevzilla]

I've worked in healthcare reimbursement, on both sides of the fence, since 1989. I don't know about "expert," but I've seen a few things.

Do you and your husband possibly have insurance with the same company? It's possible that the clueless front desk looks at your card and sees Aetna (for example) and doesn't realize the number is different from your husbands', so they assume they already have it on file. I've seen this.

 

[msudaisy26]

I've worked in healthcare reimbursement, on both sides of the fence, since 1989. I don't know about "expert," but I've seen a few things.

Do you and your husband possibly have insurance with the same company? It's possible that the clueless front desk looks at your card and sees Aetna (for example) and doesn't realize the number is different from your husbands', so they assume they already have it on file. I've seen this.

He has blue cross, I have Humana. 

 

[kevzilla]

He has blue cross, I have Humana. 

OK, we're going with the incompetence theory. Doctors and dentists make FBG money, of course, but they don't pay FBG salaries. The most effective method, unfortunately, is to use part of your precious time with the provider to complain about how your bills are being handled. They absolutely hate face-to-face conflicts with patients over business matters, and they will air out their staff and get it fixed.

Wish I had more pleasant advice, but I am myself jumping through hoops with my doctor, Cigna and Walgreens about a medication that is supposed to cost me nothing, but is currently billed at $412/month.