r/MedicalBill

I recently moved and changed dentists. I scheduled appts for myself and 2 kids for an in network dentist. After visit I received a letter from the dentist stating that dentist would be going out of network but nothing should change with routine cleaning as those visits are usually covered. I took this letter as word and should have called insurance to confirm but did not (I accept full responsibility on this). I kept my kids appts because they are hard to get and I didn’t want to have to delay if I didn’t have to and letter made it sound like there’d be no issues. 1st son went, no issues with billing. 2nd son goes a month later and insurance rejects the bill. Dentist sends me a bill showing no payments and a negotiated balance of $140, down from $268. I call insurance to inquire and they paid $68 from negotiated amount. Now I get a bill 2 months later and they say I now owe $200, which is not the negotiated rates. My son is 4 and he had a basic cleaning, dentist looked at his teeth for 2 mins and he had fluoride. This is insane. Our previous dentist without insurance was $100 for kids appts which included all of the above plus X-rays. I feel that they should a least honor the negotiated rates especially since the first bill reflected this amount and their out of network letter was misleading.

Tips for negotiating?

My wife went to the ER for what was ultimately a kidney stone back in May. We were in the ER for about 4 hours. The bill came to roughly $4600, after insurance it is $3150 for me to pay. I asked for an itemized bill, and on the itemized bill there is a $895 charge for IV fluids. She never received IV fluids. She did receive IV medications, which is also on the itemized bill. I disputed the charge and appealed it and they denied the appeal. They said "no she received the IV fluids, that/s what her records say" but absolutely 100% she did not.

I've received no good explanation for this and I swear the hospital billing office is gaslighting me now and on this last phone call they said "are you sure you're not mis-remembering".... absolutely not, my wife is a nurse and is acutely aware of the therapies she received.

I'm a bit lost at this point as to next steps. I've filed a formal letter with the hospital billing office, which they said they have not received (it's been 6 weeks). Any recommendations?

UCLA charged me $90 for a portal message 🙃
I want to call out UCLA Health because this feels like the most ridiculous lack of transparency.
After my mammogram, I got a letter saying I have dense breast tissue, so I messaged my doctor asking whether I needed additional imaging, like an MRI. My doctor was out of the office, and the covering doctor said it was an option. I said I’d rather wait until my regular doctor was back and discuss it with him and at my next mammogram.
Then I get an $90 bill for the portal message.
Nobody warned me that asking a follow-up question about my mammogram would be considered a billable medical service. No pop-up, no warning, nothing.
If UCLA wants to charge patients for portal messages, fine—tell people BEFORE they hit send. Let me decide whether I want to pay $86 to ask my own doctor a question.
Charging people afterward without clearly disclosing it feels shady as hell. Honestly, it feels like stealing from patients through a billing loophole.
Has anyone else had this happen with UCLA? Or successfully gotten one of these charges removed?

I'm trying to understand the real workflow for administrative denials, especially CO-16 cases where the RARC points to missing or invalid claim information. When you receive one, what do you actually do first? Do you open the claim in your PMS/EHR, make the correction there and resubmit? Or do you ever work directly with the 835/837 files or upload a corrected 837 through your clearinghouse? One thing I'm specifically trying to understand: if a corrected 837 were already prepared for you, would uploading that file to the clearinghouse actually eliminate work — or would you still need/want to open and update the claim in the PMS first? I'm not looking for patient data or examples containing PHI. I'm just trying to understand the workflow from people who actually work these denials.

I got a letter from insurance a couple months ago, due to a technicality they weren’t going to cover anything from my birth or my sons nicu stay. 60 thousand dollars, and I was on the hook. After months of stressing, looking into bankruptcy, and tears, I got a letter from the hospital today saying that they used their charitable fund to cover my sons portion of the bill, $46,000 of debt, gone.
I just want to shout it from the rooftops, I still can barely believe it.

State: New Jersey

** EDIT: specialty I’m seeking help for is POTS**

I finally found a specialist for a medical condition I've been urged to get diagnosed, and they accept most major insurances (including mine). Well scheduling, I was informed that there was a mandatory out-of-pocket test I'd have to take or else the doctor wouldn't see or treat me. I let the staff know he's actually tier one in my insurance so I shouldn't have any out-of-pocket costs. They said this test "doesn't have a CPT code" and for the specialty I'm being referred for, it is required by this doctor and their office. It's $250.

Now while this diagnosis is not particularly a rare illness, specialists are extremely hard to find. Usually 1-5 specialists in the entire state - and nonspecialists 99% of the time will not even discuss diagnosis. In my area, he is 1 of 2 in this specialty.

Is this illegal? I get having a preferred test that insurances may not fully recognize or cover - but making it required prior to receiving any treatment? It feels like extortion but I don't know enough about the legality of this kind of thing to say.

Not trying to defraud anyone, just not sure how this works. Hypothetical dollars but real scenario.
Let’s say an ER visit final cost is $5,000 after insurance allowed rates. I get a bill for that amount and the insurance co reduces my out of pocket deductible balance by that amount. I then negotiate a lower bill with the provider to $2,000. Does the $3,000 discount go back into my remaining annual deductible? Or does the insurance company even know? Am I supposed to report it?

maybe dumb question but i've been going down a rabbit hole on medical bills/eobs and i don't get how anyone deals with this

you get a bill. then an eob shows up with a different set of numbers. sometimes they don't even match and there's codes everywhere

and every single guide says "check your bill for errors" ok but HOW 😭😭 how do you know what's an error if you don't already know how billing works

anyway if you ever got a bill that seemed way off, what happened. did you figure out what was going on or just pay it

I am trying to dispute a charge by sounds physician as they billed my insurance for the same service the hospital did. They denied the first appeal. What can I say to dispute. They are charging $4k for a eval which was only verbal for 5 min (no other service conducted). And this was already billed by the ER.

Not sure if this is the right place to ask, but why do doctors, surgeons, dentists etc. perform any procedure without giving an estimate on the cost? How is that ok?

For example, if you take your car in for service, the mechanic with give you a quote/estimate BEFORE any work is done. Why do doctors perform anything without telling you what the total cost would be and what/if medical insurance will cover any of it? I know they can discuss with insurance before hand. I’ve seen them call and talk to insurance before.

So many people end up in crazy debt from surprise bills. This just seems horribly wrong…

This is the U.S. btw…in case it wasn’t obvious lol

I’m going insane over this. After months of going in circles, I’ve decided enough is enough and I’m sharing my experience because there’s a chance someone else is dealing with the same thing , or maybe someone here knows what I can actually do about it.
I had 2 ultrasounds at BayCare imaging facilities in Florida — one at BayCare Outpatient Imaging at Bardmoor and one at Carlisle Imaging Center.
I have Cigna insurance and both facilities are in-network.
I ended up with $900+ in bills for the two ultrasounds. According to my benefits, I expected these to be a copay, not something applied to my deductible.
I appealed with Cigna twice. Denied.
Then I talked to another Cigna rep who actually looked into the claim and told me basically: this was processed as a professional service, but because the ultrasound was done at the facility, it should have been processed under the facility benefit. BayCare needs to correct/resubmit the claim.
So I contacted BayCare.
BayCare escalated it, told me they would reprocess/resubmit the claims to Cigna, AND put my account on hold so it wouldn’t go to collections.
Great, right?
Nope. 🙃
After months of going back and forth, BayCare is now telling me “we billed it correctly, this is Cigna’s problem” and sending me back to Cigna.
Meanwhile Cigna is basically saying “BayCare needs to correct the claim.”
So I’m stuck in the middle while $900+ is sitting there as my responsibility.
And I have documentation of similar services that were processed correctly with just a copay.
I have screenshots of my benefits, the Cigna rep conversation, Cigna’s appeal decisions, BayCare bills, and the communications where BayCare originally said they would reprocess everything.
At this point I’m looking at filing an AHCA complaint against BayCare because I’m honestly out of options.
Has anyone dealt with something like this with BayCare/Cigna? Or know who I should escalate this to? Any corporate email? Is very hard to get a hold of anyone there even supervisors.
Basically: who can actually force these two companies to sit down, look at the same claims, and figure out who screwed up?

I’m located in NY and I’m uninsured. I had to have surgery a few months ago and my total bills exceeded $100,000. I was billed by the hospital, the surgeon, the anesthesiologist, and one more “specialist” for discharging me, all good there.

After a couple of months of navigating through financial assistance and waiting for a response, I decided I had to get these specialist bills paid since charity care won’t cover them anyway. No problems with the surgeon or the discharge bill, both worked with me on a cash price discount and even a “paid in full discount” and those are all set.

When I asked about the anesthesiologist bill I was told I’ve been sent to collections. After poking around a bit and getting some pushback, they revealed my account went delinquent 11 days after my final bill.

To my understanding, in NY there must be 30 days written notice prior to having a medical bill sent to collections.

Am I misinformed here? Has anyone else dealt with this?

Im waiting for a call back from the supervisor because every agent told me either the anesthesiologist billing system is down, or they just don’t have access to it.

Any input is appreciated.

I got a surgery back in march 27 that was supposed to be covered 100% by my insurance .
It ended up not being covered . I did the first appeal for 3 bills ( surgeon 2800$, anesthesiologist 2100$, and 34k $ hospital bill) and got denied . Just the surgeon’s bill is available since 33 days ago , the others are still “pending by insurance “.
I’m currently undergoing a second level appeal to the board of trustees of my union . ( my insurance is from my job).
I spoke to my surgeon’s office manager to place a hold due to second appeal undergoing and she told me:
“At this time, our system doesn't allow holds to be placed and on our end/standpoint, the EOB attached does show its PR per the denial. While patient may be appealing on their end, we cannot place the account on hold. PB DOS is aged to 35 days, they have 120 days from the first statement date before at risk of collections.
 
For Hb; it shows its still under the insurance bucket and is not currently aging at this time.”  

For my second appeal , the next meeting for the board of trustees to see my case is sept 25 .

If either way the appeal is accepted / denied .
Should I start paying in little quotes or full to prevent from going to collection? If I pay the full amount by the time I got a answer for my appeal , do I get reimbursed?
Either way I want to prevent any impact on my credit score which is 787

What is your best advise ?

I had to drop from Blue Shield of CA Platinum PPO this year down to Gold due to rising costs. (Purchased individually through Covered CA.)

I’ve noticed in MANY instances that UCLA is sending bills to BSCA with specific CPT codes and they are being processed by BSCA as “Hosp. Misc.,” which means that instead of being charged a co-pay, as I would be if they were processing the code as received from UCLA, I am instead being charged 30% co-insurance. This is double or triple what the co-pay would be.

I appealed some of these claims and BSCA just denies the appeals saying they were processed correctly. How can they be processed correctly if the CPT codes submitted by the provider aren’t what BSCA is showing on the EOB?

Is anyone else noticing this? Any advice? Is my next step to file grievances for all of these service dates with CA DMHC?

This is exhausting. I’ll be paying BSCA about $40,000 out of pocket this year. 🫠 You’d think with all of the money they bring in they could at least provide the basic services they are contracted to provide… the most basic of which would seem to be processing claims correctly. But I know that’s unfortunately not how they work….

Anyone else experiencing this? What do I do next?

Edit: I love that I can get more helpful answers on Reddit immediately than I’ve been able to get after HOURS on the phone with multiple billing departments at UCLA and multiple departments at BSCA. Everyone I spoke to at all of these departments had no idea what was happening. I mean, isn’t this what they do all day long? Again, navigating these systems is so exhausting. Thanks to those who commented. I’ve always gotten “facility fees” at UCLA, but I think when I was on the platinum plan I wasn’t as shocked by them as they were a 10% copay vs a 30% copay on the Gold plan. (Another confusing thing - why call the plan “Gold PPO 80” when it’s actually only paying 70%? 🤔)

I developed an umbilical hernia while pregnant and was referred to the local large hospital system via my PCP. They are in network with my insurance. The hospital system scheduled me a consult appt at their ambulatory surgical center. As is my habit since I’m a provider myself, I called to make sure it would be in network and they confirmed it was. I also did the early check-in via MyChart, which confirmed my insurance info and said I had a copay for the specialist visit (as an aside, I have $0 coverage for out of network providers). I signed the no surprise billing paperwork at this time as well.

Fast forward to after the visit and two claims are sent- the hospital facility claim and the provider claim. The hospital facility claim goes toward my deductible and I pay it ($297 lol), but the provider claim is denied as out of network. This was in March. I’ve spent months back and forth with my insurance (who has actually been surprisingly helpful) and the hospital billing department. Basically, it looks like they made a mistake and didn’t realize this provider’s network affiliation had accidentally either lapsed or not started (I get different answers)- she was in network officially 3 days AFTER my appointment. My insurance company is adamant I should not have to pay the balance, but the hospital says I absolutely owe it.

The billed amount for the surgeon’s claim was $487. My copay was $90, so they’re trying to collect another $397. My EOB from the insurance company shows that if the provider had been in network, the allowed amount was only $127 total. I offered to pay the $37 my insurance would have paid, but the hospital said no. I’ve appealed twice and am waiting on my second result, but I’m so frustrated. I absolutely would not have seen this provider if I’d known they were out of network. This entire facility shows as in network online, and the hospital (incorrectly) confirmed she was in network prior to the appointment. They even collected the in network copay, as stated above. Do I have any recourse?