Robert Wood Johnson University Hospital - Billing Department

atient complaint is about 2 separate accounts. She was the patient in both cases. The basic problem with both is that the patient did not supply [redacted] information to the hospital timely and apparently [redacted] is her primary insurance. Account # [redacted] 12/31/14, [redacted]...

[redacted], total charges = 2294.00. Pt provided [redacted] ID # [redacted]. Hospital billed [redacted] denied due to other info needed from subscriber. When this occurs, we send a bill to the patient, and the payer typically also sends notification to the patient to provide whatever info is needed. Pt called hospital 3/27/15 and provided [redacted] insurance information. [redacted] responded that the policy was not active on the date of service. Called pt and advised of same. She called back on 4/17/15 and provided [redacted] info. We attempted to bill using ID #' s [redacted], and [redacted] was the original ID # that came back needing additional info from the payer, one of the other policies was dental only, and the other one expired in 2013. The patient called back 9/24/2015 and provided [redacted]; asked us to bill [redacted] primary, [redacted] secondary. When we attempted to verify the [redacted] coverage, we were advised that the patient had to call in to update/clarify coordiation of benefits information before they could process claims. We left a message on the pt. answering machine notifying her to contact [redacted]. NOTE: at this point, the account was past timely filing limits for [redacted]. No further contacts from the patient about this account until contact from Revdex.com. We never had any questions regarding the charges on this account. The second account: Account number [redacted] Physical therapy evaluation 3/16/2015, Charge = 656.00 Patient provided [redacted]nfo. We billed [redacted] who processed the claim and applied 447.44 to the pateint's deductible. We wrote off $208.56 per our contract with [redacted] and billed [redacted] for $447.344 beginning July, 2015. The first time the patient responded to this billing was 12/23/2015. At first, she disputed that she was a patient on 3/16/15. After some discussion, she stated she only had a PT evaluation; we confirmed that she was only charged for an evaluation and that [redacted] processed the claim to her deductible. We provided [redacted] with a copy of her bill on 1/4/16. [redacted] then provided her [redacted] insurance info. We were able to verify again that she had an active policy but that the insurance company needed her to contact them regarding her coordination of benefits. We left a message for her advising same. I billed the claim to [redacted] today. However, due to timely filing limits, the claim will most likely deny. The "rub" here is that [redacted] will deny and expect the hospital to write off the balance. We will not do this because we weren't negligent. We cannot submit claims if we do not have information. Providing hospitals with complete and correct insurance information and complying with insurance company inquiries are patient responsibilities. To date, we have no indication that the patient ever communicated with [redacted], or [redacted] about coordination of benefits. We don't know why she didn't provide us with the [redacted] information, as she was apparently fully insured at the time of both of these bills. Unfortunately, without her providing information to the hospital or the payers timely we could not be paid. I recommend that this patient contact [redacted] and ask them to waive timely filing. We can provide her with anything she needs to submit the claims to them. However, we will not write off any accounts denied because we did not have what we needed to obtain payment.