Submitted by Backer2017 t3_zp03ny in personalfinance
In August 2021 I had a number of teeth extracted in an oral surgery procedure. They sent me a treatment plan ahead of time that outlined ~$6,500 in fees, with ~$4,000 of adjustments and an insurance estimate of ~$2,000. This meant I had ~$500 that I owed, which I paid at the time of the procedure.
The procedure went well and I thought that would be the end of it. However, in October 2021 I got an email from the insurance company that I had a new EOB available. I logged in to the portal and saw that the claim(s) were denied due to lack of information (they actually showed two different EOB’s for the one procedure because I guess they split everything into two claims). I called the oral surgeon’s office at this time and was told not to worry and that they would be resubmitting.
They resubmitted a couple more times over the course of the next few months with the same thing happening, until eventually I saw a claim was approved at the end of February 2022. Now I really thought this was the end of it until I received a letter from the oral surgeon’s office in July saying that I owed ~$1,500 and my account was past due. I reviewed the bill and noticed that insurance paid more for certain line items than the treatment plan stated, resulting in ~$2,000 being paid by the insurance company (in fact the surgeon got slightly more than they expected!) However, because they paid more for the line items, this meant I hit my maximum quicker so the second of the two claims I mentioned earlier was denied. Because of that, there are unpaid line items according to the surgeon’s office.
I called the office at the beginning of August and got directed to my insurer. There was some back and forth, my insurer called the office, and I was told there was some issue with how the claim was processed and they would submit again. This never seemed to go anywhere though and I got the exact same bill in the mail agin.
Feeling helpless, I signed up for a program through work called Health Advocate that was supposed to help with this kind of stuff. They looked into the issue, called my insurer, and told me I had met my annual maximum and would owe the rest. I called them to explain further, they called the office, and again told me I owe ~ $1,500. Every time they need to do something though, it seems to take a week and we are still right where we started. Now they are offering to transfer me to their billing savings department but I don’t know if this will help.
As so much time has passed, I am worried I will get sent to collections. I don’t feel I should have to pay any more out of pocket because the office already got more money from insurance than expected, but I’m wondering if I should just give in and pay to avoid my credit taking a hit and end this stress? Do I have other options?