Dr. Peter Gott healthy living Clip causes a financial clipping
Q: I have a disputed claim with my local hospital and am becoming agitated about it. In 2005, I had a needle biopsy, and a clip was inserted in one breast. Then, in 2007, I was sent by my doctor for a routine mammogram. His requisition specifically called for a "routine screening." The hospital billed the service as diagnostic because of the clip. My insurance company will pay for one free preventative screening mammogram each year. However, diagnostic services aren't covered, and I have a $36.42 charge that insurance won't pay.
As if this weren't enough, the radiologist billed for a diagnostic service, and I have a $65.75 bill from them, which my insurance company again will not pay. So far, my "free" mammogram is costing $102.17. I feel this is discrimination. I asked my local hospital to send through a corrected bill and have been told resubmission would constitute fraud. Why? All I want is the correct information sent to my insurance company so it will pay the claim. I shouldn't have to be out more than $100 because of an incorrect statement. What's your take on this?
A: Frankly, we all make mistakes at one time or another, and I cannot see anything wrong with your health facility issuing a copy of the original claim along with a letter explaining what occurred. There is no fraud involved, simply an error on the part of the insurance clerk.
The one issue I can see looming is the time involved. Most insurance companies have a limit as to how long following a service they will recognize a claim. Since this happened in 2007, it is my guess they will not reopen the case. I am not sure whether the hospital or radiologist can write off the charges. My guess is that they can't. I side with you and believe you are doing everything you can to rectify an error that was not yours.
