My wife had given birth at North Austin medical center and she had insurance from KP which is a PPO plan (Kaiser permanente insurnace -> PHCS provider network -> Provider) . While joining we verified the hospital is in the provider list and delivery went smooth and here goes the issue with the claim processing
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Hospital billed insurance for ~$13K ish.
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Insurance has processed the bill, considered hospital as non-participating provider and paid 60% (~$8k) and hospital sent me bill for remaining ~$5k
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I was shocked and called back insurance, they realized the claim has been processed wrong and verified that provider is in-network. The overpaid the provider at first. After contract rate adjustment claim total is ~$2.7k with $0 copay. Insurance reprocessed the claim and asked the provider to return the overpaid money.
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From there on, provider is not accepting this and keep on sending me bills for payment of ~$5k. They say they are not contracted. Even after insurance provides them with explanation of benefits and contracted rates from PHCS.
Verified with PHCS network that they are in-network as of the date of service and even now.
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I tried to bring all 3 on the same call (Insurance, Provider billing dept, me) and we discuss provider has to correct the bill, but a week later they get back with the claim to pay me $5k and they didn't reimburse overpaid money to insurance.
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Every-time I call provider billing dept, new representative lifts the call they don't even bother to find all the notes and talk very rude that I've an outstanding bill.
How to end this stalemate. Insurance was patient enough to provide them with all explantation of benefits and all the details as they requested.
Any pointers on this would be really helpful
Submitted January 30, 2018 at 10:07AM by chanducrr http://ift.tt/2rQ30q5
