Made payments on outpatient medical expenses and "not covered" since COB was not updated
Hi all,
I'm on my husband's health insurance plan through ASR as I'm a stay at home mom so I have no health insurance of my own. We found out we were expecting a baby earlier this year and I had multiple OB visits with ultrasounds, lab work, etc., that when receiving the bill I was paying as I knew the insurance wouldn't kick in until the deductible was met ($3k for family). It wasn't until I started questioning why I was responsible for 100% of the expenses still when I knew I had already made over $3k worth of payments and the "deductible accumulator" tab on our insurance website was not budging and was sitting around $1200.
I contacted the ASR insurance and they said that they needed me to update COB information as things were being processed as "not covered" because of that. I informed the representative that I didn't have any other insurance as I'm not employed and stay at home with our daughter. She said she would update my file and that all of the claims that were "not covered due to needing COB updated" would be reprocessed… which was a lot of them.
I'm now at a point where the "allowed amount" which I understood as the agreement of price of the testing between our insurance and the provider in each claim is less than the amount I had already paid. For example, an ultrasound claim from my OB was "not covered" and I paid $170 for it but after the claim was reprocessed correctly, the portion I am responsible for as the patient is $91.18.
I have a handful of these to go through and the insurance representative said I needed to call each office to notify them of the reprocessed claims as it could be "years" before I see a refund. I started with the billing department at my OB office and they are giving me push back saying they needed to reprocess the claim and once they get paid from the insurance, they would refund me the difference. I told them that the claim had already been reprocessed by my insurance and that the portion I am responsible for is what is applied to my deductible so they wouldn't be getting paid from the insurance. I noticed on the insurance website that they (OB office) submitted another claim for the same visit which was "not covered" because "These charges were previously considered in a previous claim."
I hope this all makes sense and maybe someone can give me an insight on how to better approach getting some of my money back lol.
submitted by /u/No_Albatross_7089
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