Question about billing and insurance

I had a surgery procedure for a miscarriage. Afterwards I was having pain and spotting, had to go back in for an ultrasound. Dr made me do another procedure (pill) at home and they covered both those services.

A few days later I was still having pain and called my doctor and my OB ordered a CT since I had still been spotting over the weekend and was having pain in my pelvis.

My doctor is an in network provider with an agreement. But the claim was denied because the provider did not obtain prior-authorization and it was deemed medically unnecessary by the insurance company. The EOB says the provider can’t bill this patient.

I got a letter saying the claim was denied and the provided could appeal but not bill this patient unless they had it in writing.

I’m afraid the providers general paperwork has one line that says “I agree that I (or the patient) am financially responsible for charges not paid according to this assignment” in their fine print.

The provider filed an appeal, and I got another letter saying they field the appeal. I also got another letter saying the appeal was denied (they were both dates 06/05 so wow, fast review process 🙄)

Does this mean the provider can bill me? Or does the provider have to write off the cost as my insurance said?

submitted by /u/RipleyG1026
[comments]