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Out of network provider wants to now bill me????

vic120

Guru
5000 Post Club
7,928
OH
I had a change of network this year, I had given all my providers new ins information this year

I use a medical equipment provider for cpap supplies

We had noticed I had not got bills and had been trying to contact them for months to find out why, But virtually no communication and it has been impossible to speak with someone since covid they still say its because of covid

Finally got voice message yesterday they are out of network and we will be billed

Now it is Aug it will be nearly $1500 that will not be going to my large deductible. Actually trying to reach someone to discuss this but cant ever get any response from them to easy as it took months to get this answer

AM I going to be responsible as they say even my ins company ways I will be responsible

I really don't get it though, I mean if I went to a store and bought things with a discover card and they don't take discover they wont let me leave the store and charge me later

I would never have agreed to pay for this out of pocket not going to deductible
 
I had a change of network this year, I had given all my providers new ins information this year

I use a medical equipment provider for cpap supplies

We had noticed I had not got bills and had been trying to contact them for months to find out why, But virtually no communication and it has been impossible to speak with someone since covid they still say its because of covid

Finally got voice message yesterday they are out of network and we will be billed

Now it is Aug it will be nearly $1500 that will not be going to my large deductible. Actually trying to reach someone to discuss this but cant ever get any response from them to easy as it took months to get this answer

AM I going to be responsible as they say even my ins company ways I will be responsible

I really don't get it though, I mean if I went to a store and bought things with a discover card and they don't take discover they wont let me leave the store and charge me later

I would never have agreed to pay for this out of pocket not going to deductible


Non-par providers is always a way to get "stuck" and one of the reasons why my Medicare block is "pure" FFS.

I also understand you don't have a choice due to your young age (not Medicare eligible) and probably a dearth of PPO options.

If you have an HMO you are almost assuredly going to be 100% responsible, going out of network and not an emergency situation. I am not blaming you, this is the way these plans work.

OTOH if you have a PPO there might be some wiggle room.

I couldn't find rules for timely submission of claims in TN but many states 12 months appear to be standard. In other words, if the bill was not presented to your CARRIER within 12 months the provider can't collect. Some places allow up to SIX YEARS for a provider to submit a bill.
 
He’s 99% got an HMO on aca . I find it hilarious how med sup only guys use fear of networks to scare people .Right now 99% of drs are in network with either United or Humana the biggest mapd carriers . Med sup will be reserved for the wealthy only as rates continue to rocket . I see the med sup migration to mapd this aep the biggest ever .
 
Non-par providers is always a way to get "stuck" and one of the reasons why my Medicare block is "pure" FFS.

I also understand you don't have a choice due to your young age (not Medicare eligible) and probably a dearth of PPO options.

If you have an HMO you are almost assuredly going to be 100% responsible, going out of network and not an emergency situation. I am not blaming you, this is the way these plans work.

OTOH if you have a PPO there might be some wiggle room.

I couldn't find rules for timely submission of claims in TN but many states 12 months appear to be standard. In other words, if the bill was not presented to your CARRIER within 12 months the provider can't collect. Some places allow up to SIX YEARS for a provider to submit a bill.


don't get me started My card says PPO but they say it means something other then preferred provider, In fairness I didnt buy thinking it was PPO it is HSA but that is an argument for another day

My thing is I didnt agree to get supplies for 8 months from a non participating provider\

The only reason I found out is we have been trying to contact them for months trying to find out why we haven't got bills, As I should be done with deductible now except I have not paid the CPAP supplies it was throwing me off

After Months of no replies and still getting supplies, I finally got a message a few days ago stating I am out of network

In fairness I have still not yet got a bill only I have been told I will

My thing is this , I DID NOT AGREE to take supplies form out of network provider, If I went to a store and tried to pay with discover card, And they don't take discover, They wont let me go home then try and bill me latter?? nor if I had something on auto pay and I changed card, discontinued card on file, They would not continue to give me service then bill me for 8 months worth of service and expect to be paid

why in the world should they expect to be paid for 8 months of supplies they should have contacted me within a couple months at most

I feel this is unacceptable in any other industry why should it be acceptable here

I understand out of network is out of network I could even understand something going for a month or 2

I just cant accept 8 months of service that is excessive and don't see how I should be responsible for 8 months of service

I called today again and answerer 40 minutes of dumb questions with the promise I could speak with a manger after and then was on hold for another halve hour to be told no one is available now


honestly don't know when I will get a bill and feel like I will never speak to anyone who is not overseas and not speak with anyone who has a clue anyway

But I swear in any other industry 8 months and you could tell me I was out of network that should not be my problem not after the 1 month 2 if I am really overly stretching it in fairness
 
I feel your pain . . .

Sounds like a carrier AND provider issue.

Providers want to get paid. I can't imagine them waiting 6 months, 8 months or longer to bill your carrier. Most will file claims with the carrier in 60 days or less, and generally during the first 30 days after the claim is incurred.

Have you logged into your carrier account to see when these claims were filed and how long they rattled around in the home office before the light bulb went off?

When I first went on Medicare my doctors (only 2 of them) filed with Medicare . . . then Medicare kicked it back to the provider because THEIR (Medicare) records indicated I still had BX group insurance as a dependent under my wife''s plan. This went back and forth for a couple of months before the providers called to make sure I had Medicare.

Wife had to call HR and BX to tell them to take me off the plan and tell Medicare I am no longer on the group plan. Bear in mind, BX was not deducting premiums for Rachel's dependent, so they kicked my claims out after Medicare rejected them. It took almost 4 months to get all the records straight with Medicare.

Point is, my claims were filed on a timely basis (within 30 days or so) but rattled around for almost 4 months before they were paid. So 8 months is crap.

Between the provider and your carrier, SOMEONE should have notified you before August.

Check your EOB statements, online plus any you may have received.

Unfortunately, a lot of these mangled care plans require you to be a detective. Imagine how the folks who buy these plans feel. My primary doc has told me more than once, that most of the folks that come in have no clue how their plan works.
 
don't get me started My card says PPO but they say it means something other then preferred provider, In fairness I didnt buy thinking it was PPO it is HSA but that is an argument for another day

My thing is I didnt agree to get supplies for 8 months from a non participating provider\

The only reason I found out is we have been trying to contact them for months trying to find out why we haven't got bills, As I should be done with deductible now except I have not paid the CPAP supplies it was throwing me off

After Months of no replies and still getting supplies, I finally got a message a few days ago stating I am out of network

In fairness I have still not yet got a bill only I have been told I will

My thing is this , I DID NOT AGREE to take supplies form out of network provider, If I went to a store and tried to pay with discover card, And they don't take discover, They wont let me go home then try and bill me latter?? nor if I had something on auto pay and I changed card, discontinued card on file, They would not continue to give me service then bill me for 8 months worth of service and expect to be paid

why in the world should they expect to be paid for 8 months of supplies they should have contacted me within a couple months at most

I feel this is unacceptable in any other industry why should it be acceptable here

I understand out of network is out of network I could even understand something going for a month or 2

I just cant accept 8 months of service that is excessive and don't see how I should be responsible for 8 months of service

I called today again and answerer 40 minutes of dumb questions with the promise I could speak with a manger after and then was on hold for another halve hour to be told no one is available now


honestly don't know when I will get a bill and feel like I will never speak to anyone who is not overseas and not speak with anyone who has a clue anyway

But I swear in any other industry 8 months and you could tell me I was out of network that should not be my problem not after the 1 month 2 if I am really overly stretching it in fairness

You can try this route: The No Surprises Act

Complaints about medical billing | CMS
 
I call BS.

Please show your work . . . or STFU

I’ve written 573 mapd the last 12 months . 97% have been ppo’s . I can recall not one instance were the dr has not been in either United or Humana’s network . Every qtr with earnings all carriers post there last 10 yrs total med sup and mapd quarterly total policys . Outside Aetna every single carriers med sup policy count is flat from 7 years ago . Mapd is growing at 9% plus a yr and the total # of mapd far exceeds med sup now ( 6 million plus still on original Medicare only and that’s why it’s neck and neck ) . Do you really believe any dr or hospital can refuse to not accept over 50% of the mkt and stay in business ? Those #’s are getting more lopsided every yr . Your a older senior citizen who refuses to accept the freight train called mapd
 
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