Yet another ambulance surprise billing question
Hi everyone,
I’ve been dealing with this one for a while, I live in IL.
In January 2022 I fractured my femur skiing in Colorado. Naturally I had an ambulance ride from the resort to the local hospital for surgery.
A month later I receive a bill from the ambulance service. I submitted my insurers information (United Healthcare) for it to be processed.
After processing the EOB stated these line items were paid:
Then a bunch of other line items
All of these are listed on the EOB with a code 3C-
BENEFITS FOR THIS SERVICE ARE DENIED. THIS BILLING DOES NOT COMPLY WITH NATIONAL/INDUSTRY CODING AND PAYMENT STANDARDS. WE’VE SENT YOU A LETTER WITH ADDITIONAL INFORMATION. PROVIDER: THIS DECISION WAS MADE BY MEDICAL AUDIT & REVIEW SOLUTIONS (MARS) ON BEHALF OF UNITEDHEALTHCARE. DO NOT BILL THE PATIENT FOR THIS SERVICE. FOR MORE INFORMATION ABOUT THE DENIAL GO TO PROVIDER.MARSAUDITOR.COM OR CALL 800-239-6217. IF APPROPRIATE, YOU MAY SUBMIT A CORRECTED CLAIM FOR THE PATIENT. MEMBER: IF YOU QUESTIONS ABOUT THIS CLAIM, PLEASE CALL THE MEMBER NUMBER ON YOUR HEALTH PLAN CARD.
I’ve been receiving bills from the ambulance company for the balance (just the coinsurance and the ancillary items above) every month for the last year. Everytime I call UHC and tell them I’m receiving balance bills and they tell be I shouldn’t be. They say they’ll look into it. Every now and then the claim will be reprocessed with the same result. Eventually I got put through to a claims specialist who essentially said…
Billed separately for supplies. Determined that these charges should not have been charged. Apparently it was determined that it needed to be appealed. I’ll investigate and call within a week.
She called me today and said that the claims department has determined there is nothing they can do and told me that I can appeal.
But no one is really telling me what the hell is actually wrong and how I can fix it. I reckon if I submit an appeal the same result will occur with the same denials.
So really my questions is: What could have happened here? How can I fix it? Who do I contact for the next move? The provider for incorrect billing? The insurance company for incorrect processing?
Or should I just pay the bill and send it to my travel insurance company who has already covered the rest of my OOP costs from this incident.
Cheers
