Doctor refuses to bill my child’s primary insurance after denied secondary billing (due to birthday rule).
Location: California
My child has a primary HMO and secondary PPO.
The HMO does not cover the doctor, whereas the PPO does.
The doctor billed the PPO, but was denied because they need to bill the HMO first and get their denial first; the denial EOB from HMO is supposed to get sent to PPO for successful processing. This is due to the "birthday rule" where the HMO insurance is from my spouse who has an earlier birth month.
The doctor refuses to bill the primary and go through the additional hoops and they sent me a $1000 bill for multiple visits.
Any options for me on how I can get things resolved so I don't have to pay out of pocket? I already called both insurances and they say they can't bend on the birthday rule.
Edit:
The reason we started having this problem is my spouse got a new job which came with free HMO, so we thought it was a no brainer. We still want my PPO to be conservative. We didn't know about the birthday rule at the time.
submitted by /u/banstick86
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