Primary and secondary insurance mix-up.
I was seeing my usual medical provider with my usual insurance, but at the same time I was also newly enrolled in my partner’s insurance a few months before, making my usual insurance the secondary and my new insurance the primary (I didn’t know this rule at the time). That made my provider out of network with primary and in network with secondary. Half of the claims have already been paid by the secondary insurance until they learned they were the secondary, they haven’t recouped the money yet (it’s been 3 months – do they always do it?) but they denied the latest claims “due to another insurance” The provider’s billing dept have been pressing me to take a payment plan or go to collections. They want to charge me for all services $3800 (even they ones the secondary insurance paid and hasn’t recouped) They don’t want to re-submit the claims with my primary insurance “because they will pay very little”, and neither to the secondary insurance that they’re in network with “because they don’t have the bandwidth to attach the Explanation of Benefits”. I told them I have no means to self pay and offered to submit the claims myself since they don’t want to do it and when I get the money I would be paying them. They think l’d just keep the money and not pay them so they refused to provide me a bill with the diagnostic and billing codes, which id need to fill out the claim form. Do they have the right to refuse those two things? The bill with diagnostic and billing codes and to re-submit the claims with both insurances, one in network. Also, do insurances always recoup the money? Isn’t the provider double charging in this case? I appreciate your advice.
submitted by /u/hayne212
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