Provider used the wrong code, refuses to fix it.

So about a year ago, my spouse who has a congenital heart deformity and gets stress-tested and imaged (CT or MRI, one of the two) every 12-24 months as preventative screening for heart problems. This was covered by their parents’ insurance for over 10 years as preventative care.

Last year, they lost their parents’ insurance, and we started using Empire BCBS thru my employer. Regardless, they’ve had the same cardiologist since they were ~19. But when they went to get the screening done in January, their doctor’s clinic entered in a diagnosis code that wasn’t preventative. We got hit with an unexpected $1,000 bill.

Since then, no one has been much help. We kept on getting tossed back and forth btwn our insurance and the hospital and finally learned that the mistake was the hospital’s. The hospital refused to issue a new claim and insurance refused to help, saying that we have to talk to our provider to get it fixed. Is there any way to force the hospital to address this issue, esp. this long after the initial claim was processed?

submitted by /u/kaytralguna
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