What’s my actual "non-covered" patient responsibility for a previously processed claim?
In Michigan.
I had a claim in July 2023 for a $195 specialist visit that went to insurance; insurance did its in-network discount, and says I owe $84 to deductible. I called the provider repeatedly last summer to try to pay, but they said they hadn't gotten the EOB and so would work with insurance and get back to me. (I had this conversation a couple of times.)
The provider resubmitted the claim twice in May 2024; I now have two new EOBs, both with a "non-covered" patient responsibility of $195 (the full charge). Both EOBs clarify in the notes "This service has been billed and previously processed." Provider has also just sent an invoice for the full $195, with a note claiming that the insurance provided at the time was "not valid" and didn't cover their charges.
Couple questions: (1) am I responsible for the full $195 or the original $84? By my reading, it's $84, and the $195 is just a function of them re-submitting (multiple times). (2) is this a balance bill, which is illegal in Michigan, or otherwise fraudulent in some way?
I'll hopefully have slightly more info from insurance provider when they're open tomorrow.
submitted by /u/KwehTheGreh
[comments]
