News

HOW TO SOLVE YOUR OWN MEDICAL BILLING MISHAP

Step-by-step guide to resolving common medical billing problems without professional help.

DJ
RCM Manager · 24/7 Medical Billing Services
Reviewed for accuracy by 247MBS certified coders
Published October 19, 2015 2 min read

MONTGOMERY, NY (WABC) --

The stress of the debt one family has been fighting has gone on for a year.

"It was frustrating. It was horrific. And it was hurtful," said Martin Maturine.

The last time the leaves were changing around Donna and Martin Matiruine's Orange County home, Martin was fighting for his life.

"My liver had gotten to cirrhosis. It was in the first stage or cirrhosis, yeah," said Martin.

Martin contracted Hepatitis C 20+ years ago from a blood transfusion while suffering from an ulcer. The new treatment offered by New York Medical College was a chance to finally stop the silent disease's progression.

"I was so happy there was something new with minimal side effects," said Martin's wife, Donna.

The regimen was a huge success, but then came the bill from Westchester Medical Center, putting the patient on the hook for more than $2,500.

"The insurance says I'm not liable. (But) the hospital says I am," said Martin.

That's right, their insurance, Empire BlueCross BlueSheild had pre-approved the therapy, stating the Maturines didn't owe a dime.

But despite Martin's calls, and angry emails from his doctor's office to the hospital. Which Martine read, "...Attached is another example of how Westchester Medical Center is ignoring our patients when they shouldn't have been billed."

Westchester Medical sent him to collections. Then sicced an attorney on them. The message? Pay up or get sued. The Maturines turned to us for help.

"You know I had the coverage, you know its available, you don't owe anybody any money and neither party wanted to take a closer look at," said Martin.

So we asked all parties to take another look. Empire told us it had mistakenly coded part of the coverage. And days after our calls...

"I owe nothing. I owe zero. They made a mistake with the billing and we owe nothing," said Martin.

Their outstanding bill was finally reconciled.

Westchester Medical had no comment. Empire BlueCross BlueShield thanked us for bringing this to our attention, saying it never knew of the problem. Their big takeaway, if you're not getting costs covered, appeal through the insurance company. You're allowed 2 appeals through the insurance company and 3rd appeal through your state department of insurance.

Source: http://abc7ny.com/

Tagged
DJ
RCM Manager · 24/7 Medical Billing Services
Danny writes on specialty medical billing, coding compliance, and revenue-cycle strategy, translating complex CMS and payer rules into practical guidance for practice administrators and physicians.
Work with a specialty billing partner

Stop losing revenue to preventable denials

247MBS runs your billing on true specialty depth — clean coding, correct modifiers, and denials worked to root cause on every claim.

Request a Revenue Review or call +1 888-502-0537