This has been resolved I contacted [redacted] to review the outcome of my findings Here is a summary of the review:Baby's father's UHC was billed and paid 5/6/ We were not provided with UHC secondary until 6/2/ Our system indicates that a request to generate a claim was processed on 6/3/16.The account went into a holding pattern with the belief that UHC secondary had the claim After investigating, it was found that our system did not produce the claim as it shouldThis was not discovered until 3/16/After this time, UHC provided feedback to [redacted] that the baby would have been covered for the first days This was contrary to what the UHC claims department told MCHS each time we called.After further investigation, it was clarified that a baby is only automatically covered when the policy holder is the biological mother/father Since the policy holder is the grandmother, this automatic coverage rule does not apply Both [redacted] and [redacted] were provided with misleading and incomplete info from UHC Since the baby was never added by [redacted] to the policy, there was no coverage Additionally, all of the letters and correspondence we received was listed under [redacted] instead of [redacted] since UHC did not acknowledge [redacted] as being covered This is again why UHC provided misleading and inaccurate information about never receiving a claim.We do have the authorization to bill the pts mother for the balance left by the primary UHC policy since the baby was not added and UHC would not have processed the claim as secondary even if the claim had gone to them back in 6/ Additionally, UHC sent the policy holder [redacted] letters requesting additional information to support processing the claim which UHC indicates was not responded to All of the information above was validated with [redacted] at UHC, ###-###-####, Ref# ***However, we have elected to allow an untimely billing adjustment to be used due to the acknowledgement that our system did experience an error back in 6/that prevented a claim from releasing when expected At this time we are not holding [redacted] liable for the balance based on all of these circumstances We have contacted [redacted] and informed her of our decision to waive the balance given the nature of these circumstances
I am still having issues with Mt CarmelThey are trying to send me to collections over a claim they did not submit in timeThe claim was submitted through my husbands insurance and then when I was first contacted by Mt Carmel, I gave them additional insurance informationThey chose to not bill it correctly and wait around until they received a timely filing notice from UHCI have a copy of this letter and so do theyI received a bill year after the birth of my childI have called numerous times to Mt Carmel, it seems we would get somewhere and I would have to explain the situation to a new person every timeThen I would receive a bill in the mail a few days laterAnd now a collections letterThis is ridiculousMy insurance company said they would pay for this service and Mt Carmel didn't even try to find out the proper way to bill and now they are trying to make me pay for something because they didn't file the claim in timeI know about medical billing and that is why I know that they can't do that, but I feel bad for all the other people they are scamming out of money because they don't know how to bill correctly and timelyPlease help!Thanks!
The request to bill the secondary UHC policy was initiated by our office back on 6/2/2016. After reviewing with our claims manager, it appears that the process may have been initiated but not fully completed and the claim may have been closed prematurely. The claims manager has sent
another request to have the secondary UHC policy billed. It will take 30-days until we receive a response from UHC in order to determine how it will be handled. The Director of our Customer Service/Collections department (*** ***) contacted the patients mother (*** ***) and explained this on 6/1/
The account was billed using the diagnosis code from the doctor's order for the xrays that the patient had done. A second set of orders was found for the lab work that contained another diagnosis code for a routine physical. Our coding department was able to add this code to the account
and it has now been rebilled to the insurance. The account has been removed from collections and the patient will receive a new statement once her insurance has had an opportunity to reconsider payment on the claim
Account Number: *** (Hospital Bill) - This account was billed correctly. *** did not deny this claim. They paid and applied $to the deductible and $to the coinsurance. Account Number: *** (Physician Bill) - This account was also billed
correctly. *** did not deny the claim. They applied the out of pocket to the patients deductible / coinsurance. Account Number: *** (Lab Bill) - This account for was billed with the same policy number as the hospital and physician bill. It does appear that the pts group number did change in from *** to ***. *** should not have denied this claim for this account since the patient did have active coverage. *** (Lab Billing Company) is following up with *** to get them to reconsider the claim since it was billed with an active policy number. They will point out that the policy was active and *** should have paid on the claim. All of the accounts that we have on file have been provided with the patients old insurance card. In order to avoid any further issues, the patient will need to ensure that they provider the healthcare provider with their most recent card that shows any changes to their group# or policy information
I reviewed the response made by the business in reference to complaint ID ***, and find the proposed resolution to be satisfactory to me if it is carried out as described
This patient was sent letters on 3/30/15, 4/10/15, 4/17/15, 4/27/15, 5/22/15, and 6/12/15. Each one of the letters indicated that the patient would need to contact us for a formal, agreed upon arrangement. Our letters also included a settlement offer (currently expired) and a financial...
assistance application. Mrs. [redacted] did not respond to any of these letters. Sending in random payments does not constitute a formal agreement. These payment plans are required to hold the account in good standings. Our system held the account in good faith, hoping that the patient would eventually pay in full or setup an arrangement with our office. She did not, so as a result, her account went to collections. We will give this patient the option of setting up a payment plan with the collection agency or making an arrangement with our Healthfirst Financial Group; both who can extend her a payment plan beyond the 90 day arrangements we have available at the hospital. If Mrs. [redacted] does not accept one of these offers, then her account will continue to be followed up on by the agency per our standard policies. I called the patient and advised that we will pull her account from collections as a one time courtesy since she agreed to setup a loan through Healthfirst Financial. The account has been recalled from agency and one of our collectors will set her up on a loan on 8/28/15. The patient was satisfied with this result.
This has been resolved. I contacted [redacted] to review the outcome of my findings. Here is a summary of the review:Baby's father's UHC was billed and paid 5/6/16. We were not provided with UHC secondary until 6/2/16. Our system indicates that a request to generate a claim was processed on 6/3/16.The account went into a holding pattern with the belief that UHC secondary had the claim. After investigating, it was found that our system did not produce the claim as it should. This was not discovered until 3/16/17. After this time, UHC provided feedback to [redacted] that the baby would have been covered for the first 30 days. This was contrary to what the UHC claims department told MCHS each time we called.After further investigation, it was clarified that a baby is only automatically covered when the policy holder is the biological mother/father. Since the policy holder is the grandmother, this automatic coverage rule does not apply. Both [redacted] and [redacted] were provided with misleading and incomplete info from UHC. Since the baby was never added by [redacted] to the policy, there was no coverage. Additionally, all of the letters and correspondence we received was listed under [redacted] instead of [redacted] since UHC did not acknowledge [redacted] as being covered. This is again why UHC provided misleading and inaccurate information about never receiving a claim.We do have the authorization to bill the pts mother for the balance left by the primary UHC policy since the baby was not added and UHC would not have processed the claim as secondary even if the claim had gone to them back in 6/2016. Additionally, UHC sent the policy holder [redacted] 5 letters requesting additional information to support processing the claim which UHC indicates was not responded to. All of the information above was validated with [redacted] at UHC, ###-###-####, Ref# [redacted]However, we have elected to allow an untimely billing adjustment to be used due to the acknowledgement that our system did experience an error back in 6/2016 that prevented a claim from releasing when expected. At this time we are not holding [redacted] liable for the balance based on all of these circumstances. We have contacted [redacted] and informed her of our decision to waive the balance given the nature of these circumstances.
This complaint was addressed by our Mount Carmel Physician Billing Department. The manager of this area contacted the patient on 10/15/15 and he was satisfied with the resolution. Below is a summary of their research:
The payment that the patient is referring to is check # 5098...
for
$20.00, that payment posted to date of service 4/20/15 (Dr. [redacted] at MCMG
Diley Ridge)instead of date of service 4/27/15 (Dr. [redacted] at MC Columbus
Cardiology) as he requested. The $20.00 that we are currently billing the
patient for is an accurate balance. The proof of the $20.00 payment posting to
date of service 4/20/15 is noted on statement dated 8/23/15. The patients current statement balance is $40.00; $20.00 for
date of service 4/27/15 and $20.00 for date of service 7/21/15. The payment was posted to the oldest date of
service, we do that to keep the patient current.
I am still having issues with Mt Carmel. They are trying to send me to collections over a claim they did not submit in time. The claim was submitted through my husbands insurance and then when I was first contacted by Mt Carmel, I gave them additional insurance information. They chose to not bill it correctly and wait around until they received a timely filing notice from UHC. I have a copy of this letter and so do they. I received a bill 1 year after the birth of my child. I have called numerous times to Mt Carmel, it seems we would get somewhere and I would have to explain the situation to a new person every time. Then I would receive a bill in the mail a few days later. And now a collections letter. This is ridiculous. My insurance company said they would pay for this service and Mt Carmel didn't even try to find out the proper way to bill and now they are trying to make me pay for something because they didn't file the claim in time. I know about medical billing and that is why I know that they can't do that, but I feel bad for all the other people they are scamming out of money because they don't know how to bill correctly and timely. Please help!Thanks!
This has been resolved I contacted [redacted] to review the outcome of my findings Here is a summary of the review:Baby's father's UHC was billed and paid 5/6/ We were not provided with UHC secondary until 6/2/ Our system indicates that a request to generate a claim was processed on 6/3/16.The account went into a holding pattern with the belief that UHC secondary had the claim After investigating, it was found that our system did not produce the claim as it shouldThis was not discovered until 3/16/After this time, UHC provided feedback to [redacted] that the baby would have been covered for the first days This was contrary to what the UHC claims department told MCHS each time we called.After further investigation, it was clarified that a baby is only automatically covered when the policy holder is the biological mother/father Since the policy holder is the grandmother, this automatic coverage rule does not apply Both [redacted] and [redacted] were provided with misleading and incomplete info from UHC Since the baby was never added by [redacted] to the policy, there was no coverage Additionally, all of the letters and correspondence we received was listed under [redacted] instead of [redacted] since UHC did not acknowledge [redacted] as being covered This is again why UHC provided misleading and inaccurate information about never receiving a claim.We do have the authorization to bill the pts mother for the balance left by the primary UHC policy since the baby was not added and UHC would not have processed the claim as secondary even if the claim had gone to them back in 6/ Additionally, UHC sent the policy holder [redacted] letters requesting additional information to support processing the claim which UHC indicates was not responded to All of the information above was validated with [redacted] at UHC, ###-###-####, Ref# ***However, we have elected to allow an untimely billing adjustment to be used due to the acknowledgement that our system did experience an error back in 6/that prevented a claim from releasing when expected At this time we are not holding [redacted] liable for the balance based on all of these circumstances We have contacted [redacted] and informed her of our decision to waive the balance given the nature of these circumstances
I am still having issues with Mt CarmelThey are trying to send me to collections over a claim they did not submit in timeThe claim was submitted through my husbands insurance and then when I was first contacted by Mt Carmel, I gave them additional insurance informationThey chose to not bill it correctly and wait around until they received a timely filing notice from UHCI have a copy of this letter and so do theyI received a bill year after the birth of my childI have called numerous times to Mt Carmel, it seems we would get somewhere and I would have to explain the situation to a new person every timeThen I would receive a bill in the mail a few days laterAnd now a collections letterThis is ridiculousMy insurance company said they would pay for this service and Mt Carmel didn't even try to find out the proper way to bill and now they are trying to make me pay for something because they didn't file the claim in timeI know about medical billing and that is why I know that they can't do that, but I feel bad for all the other people they are scamming out of money because they don't know how to bill correctly and timelyPlease help!Thanks!
The request to bill the secondary UHC policy was initiated by our office back on 6/2/2016. After reviewing with our claims manager, it appears that the process may have been initiated but not fully completed and the claim may have been closed prematurely. The claims manager has sent
another request to have the secondary UHC policy billed. It will take 30-days until we receive a response from UHC in order to determine how it will be handled. The Director of our Customer Service/Collections department (*** ***) contacted the patients mother (*** ***) and explained this on 6/1/
The account was billed using the diagnosis code from the doctor's order for the xrays that the patient had done. A second set of orders was found for the lab work that contained another diagnosis code for a routine physical. Our coding department was able to add this code to the account
and it has now been rebilled to the insurance. The account has been removed from collections and the patient will receive a new statement once her insurance has had an opportunity to reconsider payment on the claim
Account Number: *** (Hospital Bill) - This account was billed correctly. *** did not deny this claim. They paid and applied $to the deductible and $to the coinsurance. Account Number: *** (Physician Bill) - This account was also billed
correctly. *** did not deny the claim. They applied the out of pocket to the patients deductible / coinsurance. Account Number: *** (Lab Bill) - This account for was billed with the same policy number as the hospital and physician bill. It does appear that the pts group number did change in from *** to ***. *** should not have denied this claim for this account since the patient did have active coverage. *** (Lab Billing Company) is following up with *** to get them to reconsider the claim since it was billed with an active policy number. They will point out that the policy was active and *** should have paid on the claim. All of the accounts that we have on file have been provided with the patients old insurance card. In order to avoid any further issues, the patient will need to ensure that they provider the healthcare provider with their most recent card that shows any changes to their group# or policy information
I reviewed the response made by the business in reference to complaint ID ***, and find the proposed resolution to be satisfactory to me if it is carried out as described
I reviewed the response made by the business in reference to complaint ID ***, and find the resolution is satisfactory to me
This patient was sent letters on 3/30/15, 4/10/15, 4/17/15, 4/27/15, 5/22/15, and 6/12/15. Each one of the letters indicated that the patient would need to contact us for a formal, agreed upon arrangement. Our letters also included a settlement offer (currently expired) and a financial...
assistance application. Mrs. [redacted] did not respond to any of these letters. Sending in random payments does not constitute a formal agreement. These payment plans are required to hold the account in good standings. Our system held the account in good faith, hoping that the patient would eventually pay in full or setup an arrangement with our office. She did not, so as a result, her account went to collections. We will give this patient the option of setting up a payment plan with the collection agency or making an arrangement with our Healthfirst Financial Group; both who can extend her a payment plan beyond the 90 day arrangements we have available at the hospital. If Mrs. [redacted] does not accept one of these offers, then her account will continue to be followed up on by the agency per our standard policies. I called the patient and advised that we will pull her account from collections as a one time courtesy since she agreed to setup a loan through Healthfirst Financial. The account has been recalled from agency and one of our collectors will set her up on a loan on 8/28/15. The patient was satisfied with this result.
This has been resolved. I contacted [redacted] to review the outcome of my findings. Here is a summary of the review:Baby's father's UHC was billed and paid 5/6/16. We were not provided with UHC secondary until 6/2/16. Our system indicates that a request to generate a claim was processed on 6/3/16.The account went into a holding pattern with the belief that UHC secondary had the claim. After investigating, it was found that our system did not produce the claim as it should. This was not discovered until 3/16/17. After this time, UHC provided feedback to [redacted] that the baby would have been covered for the first 30 days. This was contrary to what the UHC claims department told MCHS each time we called.After further investigation, it was clarified that a baby is only automatically covered when the policy holder is the biological mother/father. Since the policy holder is the grandmother, this automatic coverage rule does not apply. Both [redacted] and [redacted] were provided with misleading and incomplete info from UHC. Since the baby was never added by [redacted] to the policy, there was no coverage. Additionally, all of the letters and correspondence we received was listed under [redacted] instead of [redacted] since UHC did not acknowledge [redacted] as being covered. This is again why UHC provided misleading and inaccurate information about never receiving a claim.We do have the authorization to bill the pts mother for the balance left by the primary UHC policy since the baby was not added and UHC would not have processed the claim as secondary even if the claim had gone to them back in 6/2016. Additionally, UHC sent the policy holder [redacted] 5 letters requesting additional information to support processing the claim which UHC indicates was not responded to. All of the information above was validated with [redacted] at UHC, ###-###-####, Ref# [redacted]However, we have elected to allow an untimely billing adjustment to be used due to the acknowledgement that our system did experience an error back in 6/2016 that prevented a claim from releasing when expected. At this time we are not holding [redacted] liable for the balance based on all of these circumstances. We have contacted [redacted] and informed her of our decision to waive the balance given the nature of these circumstances.
This complaint was addressed by our Mount Carmel Physician Billing Department. The manager of this area contacted the patient on 10/15/15 and he was satisfied with the resolution. Below is a summary of their research:
The payment that the patient is referring to is check # 5098...
for
$20.00, that payment posted to date of service 4/20/15 (Dr. [redacted] at MCMG
Diley Ridge)instead of date of service 4/27/15 (Dr. [redacted] at MC Columbus
Cardiology) as he requested. The $20.00 that we are currently billing the
patient for is an accurate balance. The proof of the $20.00 payment posting to
date of service 4/20/15 is noted on statement dated 8/23/15. The patients current statement balance is $40.00; $20.00 for
date of service 4/27/15 and $20.00 for date of service 7/21/15. The payment was posted to the oldest date of
service, we do that to keep the patient current.
I am still having issues with Mt Carmel. They are trying to send me to collections over a claim they did not submit in time. The claim was submitted through my husbands insurance and then when I was first contacted by Mt Carmel, I gave them additional insurance information. They chose to not bill it correctly and wait around until they received a timely filing notice from UHC. I have a copy of this letter and so do they. I received a bill 1 year after the birth of my child. I have called numerous times to Mt Carmel, it seems we would get somewhere and I would have to explain the situation to a new person every time. Then I would receive a bill in the mail a few days later. And now a collections letter. This is ridiculous. My insurance company said they would pay for this service and Mt Carmel didn't even try to find out the proper way to bill and now they are trying to make me pay for something because they didn't file the claim in time. I know about medical billing and that is why I know that they can't do that, but I feel bad for all the other people they are scamming out of money because they don't know how to bill correctly and timely. Please help!Thanks!