Ask Christina: Why Did My Bill Go To Collections If My Insurance Was Supposed to Pay It?

Health, Managing Medical Bills
Ask Christina

Question:

I had to have X-rays taken more than a year ago after a sports injury. I just received notice that the bill was never paid by my insurance company and is now in collections. The X-rays should have been covered by my insurance policy. What can I do?

Answer:

It’s very frustrating to have outstanding medical bills, especially when they enter collections. One account in collections can reduce your credit score significantly. There are several reasons your bill may have been left unpaid by your insurance company and several approaches you can take to mitigate the effects of the now-delinquent bill.

Did your radiologist file the bill with your insurance company?

To answer this, contact your medical provider directly. Call and ask why your account has been sent to collections. If your provider’s office never filed the insurance claim, therein lies the problem. In most cases, it is the responsibility of your medical provider to do this. If they failed to file the claim, they should remedy their error by contacting the collection agency, and the insurance company, too.

Was the insurance company waiting on more information?

If the claim was sent to the insurance company but wasn’t paid, they could simply need additional information. When an insurance company receives a claim that is lacking certain details or documentation, they normally contact the medical provider directly. But if these requests go unanswered, the claim remains in limbo and unpaid. Call your insurance company and ask what information they are missing. Also ask if and when they requested this additional information from the radiologist. Again, it’s the responsibility of your medical provider to provide the right documentation to get a claim paid, and knowing what went wrong will prepare you to speak with authority when you call the provider back.

Was your claim denied?

Generally, insurance companies send out an explanation of benefits when a claim is denied, outlining their justification for nonpayment. If you didn’t receive this, but the insurance company says your claim was denied, ask for a copy.

Denials happen for a variety of reasons, but occasionally for nothing more than a typo or coding error. If the insurance company says your X-rays simply aren’t covered, appealing that decision is well within your rights. Though the appeals process may differ slightly from one insurance company to the next, it typically involves writing a “retro authorization” request letter, which outlines the medical necessity of the treatment in question and includes documentation such as medical records from the doctor, or in this case, the radiologist.

Ideally, whoever is at fault for the delay in payment will take responsibility for getting your account out of collections. But it isn’t always that simple. Because you are dealing with an issue that could have a considerable impact on your credit rating, it may be worthwhile to look into using a medical bill advocate. These professionals are adept at helping patients navigate medical bill problems, including errors and insurance denials.

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