Bills

28 Feb

By the time fall came around, I had assumed that my insurance had paid all of my bills since I hadn’t received any more. It turns out that I was wrong; they were just very slow to reject a couple of claims. Specifically, my parents’ insurance has rejected claims from Berkeley Emergency Medical Group and the oral surgeon.

The balance with Berkeley Emergency Medical Group was only $76.30, but I haven’t gotten a bill from them yet. The oral surgeon’s bill is much bigger, nearly $2,000, because it was out-of-network for both of my insurances. The oral surgeon’s office also seems to be in a bigger hurry to get money from me. I’ve received a bill from them as well as a couple of phone calls.

The billing person at the oral surgeon’s office told me that my claim was rejected because of a non-duplication of benefits policy. However, when I called the insurance company, they seemed to be telling me that they had rejected my claim simply because they didn’t know anything about my other insurance and thus couldn’t determine how much they should pay. So I gave them the information for my other insurance, and they told me that they’d take 30-45 business days to figure things out and then process the claims again. That was about 26 business days ago, so I’ll call them again at the end of this week.

I also authorized a partial payment to the oral surgeon’s office, since I don’t want that balance turned over to a collections agency. The oral surgeon’s office seems thoroughly confused about this situation, and I really think they underestimate how much my insurance will owe. This is, after all, my primary insurance, but the oral surgeon’s office billed the other one first.

I’ve started to wonder why I was referred to this oral surgeon from the emergency room if it was out-of-network for my insurance. One possibility is that it was because the emergency room had my insurance information wrong, initially billing Blue Shield of California instead of any insurer with which I actually had a policy. Next time I talk to the oral surgeon, I’ll ask if they’re in network for Blue Shield of California. Of course, it’s also entirely possible that the emergency room just doesn’t have a policy of referring within network.

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One Response to “Bills”

  1. Sandy October 4, 2010 at 12:15 pm #

    I have blue cross blue shield and live in Austin and there was only 1 surgeon (according to the insurance company) within 30 miles of me that takes my insurance. It could be that blue cross blue shield has crappy reimbursement for oral surgeons so hardly any doctors contract with them. Just a guess, but Austin is a fairly large city with many oral surgeons, so there has to be some reason there aren’t more providers that take blue cross blue shield.

    I didn’t go through the ER in Austin since my accident happened in SD, so we had a few days to find a surgeon. Otherwise I would have likely ended up with an out of network doctor and 2k more in medical bills. Insurance is ridiculous.

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