Wrong billing codes used by hospital

Asked 6 months ago - Akron, OH

I had a pap smear done at a doctor's office and had insurance at the time of service. My insurance company told me that wrong codes were used for the claim and the doctor's office has to re-submit it using the right code in order for the claim to be processed and paid for. They said under the Affordable Care Act, pap smears are free of charge, no matter what kind of policy I have. I have been trying to contact the doctor's office about it for a year now, and they have turned me over to a collection agency in the meantime. What are my options?

Attorney answers (4)

  1. Donald Michael Gallick

    Pro

    Contributor Level 16

    3

    Lawyers agree

    Answered . I agree with the previous answers. The only thing I would add is that it might be beneficial to follow up any and all phone calls with a letter documenting your position in the dispute. Keep a copy of any letter(s) that you mail in case the matter ends up in court.

    If something isn't in writing -- it probably won't be helpful if the dispute turns into a lawsuit.

  2. Tara Candela RN

    Contributor Level 14

    4

    Lawyers agree

    Answered . That is an unfortunate situation. I suggest you call and speak to someone in their billing department or go in directly to discuss the situation with them. Do not wait for them to call you back. If your insurance company is willing to take a resubmission, they should handle that for you, or give you the appropriate information so that you can do it yourself. Options beyond that depend on how much time and effort you want to put in to dealing with it. Do a cost-benefit analysis.

  3. Daniel Lee O'Neil

    Contributor Level 18

    1

    Lawyer agrees

    Answered . Tara provided great guidance. Go in person and discuss with billing/accounting. They should handle the resub or basically do it for you and let you actually send it. Best of luck

    Statements posted on the Avvo Q&A section are not legal advice. No prudent person anywhere at any time should ever... more
  4. Scott Charles Glovsky

    Pro

    Contributor Level 7

    1

    Lawyer agrees

    Answered . Contact your insurer directly and file a grievance. And let them know you will file a complaint with the Department of Managed Health care if they do not resolve the problem promptly.

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