What do I do if I'm getting calls from a collection agency for a doctor's appointment that my insurance should have covered?

  • by Brian Hates Himself
  • Sep 11,2017
  • 12 answers

I went to the same doctor I always see and have for three years now on 9/8, just a few days ago. Today I got a voicemail saying that my insurance didn't cover it. It was a physical and getting my blood drawn. I watched the woman scan my insurance cards.
When I try to call back, no one answers and I've been trying for an hour now.


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Insurance Answers (12)

Casey Y 2 months ago

Call the company...any chance your plan changed? Confirm they received the submission and whether it was denied, then ask why.
Ultimately, you may be on the line for the bill.

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StephenWeinstein 2 months ago

You pay it.
Just because she scanned your insurance cards does not mean that the insurance should cover it.
If there is some other reason why the insurance should cover it, then you pay the bill immediately, and then submit a written claim for reimbursement to the insurance company, by mail, without using the phone.
You do not call.
The MOST important thing to remember when it comes to credit is that you NEVER speak to any collection agency on the phone, ever, for any reason. If they leave a message, you do not call back. If they call and you answer, you hang up immediately. You do not even say "hello" or "good bye". You communicate only in writing, and if you can't say something in writing, then you don't say it.

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Judy 2 months ago

Firwst of all, if you just had the service last week, it's not a collections agency calling. But different policies have different things they cover. Call your insurance company tomorrow and ask.

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Texperson 2 months ago

You should: 1. call your doctor's office and see if they sent your bill to your insurance company. Sometimes they mess up and forget or send it in under a wrong name or acct. number. If they did it correctly then, 2. Call your insurance company and ask why they didn't pay the claim.
Don't call the collection agency, it could be a scam. Do your own checking into the bill.

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Fraggle 2 months ago

Contact the insurance company to find out why it was denied. It's possible there was something as simple as a coding error by the doctor's office. You should also follow up with the doctor's office.

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Beverly S 2 months ago

Call your insurance company & ask why not covered. They may no longer be in your network. By the way a collection agency isn't calling you about a bill from 3 days ago. It's your doctors billing agent.

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mermeliz 2 months ago

You should do two things!
First go down the the doctor's office and talk to the finance/billing person. If you have ANY paperwork regarding that actual visit, then bring it. (NOT the collection agencies bill)!
Also contact your insurance company to find out if they have received a billing for this office visit. Then go from there.

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Elaine M 2 months ago

Get the phone number of the insurance company and when the collection agency calls inform them that the insurance company is still working on it and if they have any questions, then here is the number to call over there.

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Stan 2 months ago

Call the insurance co and just ask why it was not paid.

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Cupcake's Princess 2 months ago

You are responsible for paying whatever insurance doesn't. Call the doctor's office and ask them to submit the claim. However, if the claim is more than two years old, the insurance company doesn't have to go back and process it now, in which case you're responsible for the whole bill. It doesn't matter that no one told you the bill was outstanding until now. When the insurance company processes a claim, they send you an accounting of that payment (called an Explanation of Benefits, or EOB for short). It is up to you to be sure that you get an EOB for every claim that should have been filed. If you don't get an EOB in a reasonable amount of time, then you should follow-up with the provider and/or insurance company. But, in the end, you're responsible for the bill.

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Bostonian In MO 2 months ago

You will get an EOB from the insurance company that explains why the procedure was not covered. At that point you should have some idea how to proceed. It's possible that it was not correctly coded by the billing associate but it's also possible that it is not covered.
One of the things that you signed when you checked in at the doctor's office was an agreement that you were responsible for the charges and that they only submitted the billing to your insurance carrier as a courtesy to you. Therefore if the procedure is not covered by your insurance, you are responsible for the full amount billed.
If you are in fact liable for the bills, ask the billing office for the best rate discount offered to insurance companies and offer to pay that amount instead of the full amount billed. The amounts billed by most doctor's offices, labs and hospitals don't bear any resemblance to what they actually are paid by the insurance companies. My doctor bills $175 for my 6-month checkups but the insurance company negotiated a rate of $65 -- a 63% discount -- and between what the insurance company pays and my copays, that's all that he receives. The blood work is even crazier. It's billed at nearly $400 but the negotiated price is only $25. That's a discount of nearly 94%!
As an aside, for services delivered on the 8th, this is nowhere near going to collections yet. The billing office is just telling you that you have to pay. But wait for the EOB before you hand over any cash.

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H. Marie 2 months ago

take it all back to your doctor, if he didn't order the blood draw and the physical but was something of your choice, it may not be covered by insurance, it could be something you will pay for

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