Insurance Coverage

[Timothy42]

What is the name of your state? Ohio
My wife and I carry separate insurace through our work and work for different companies. I am not covered on hers nor is she coverered on mine. Am I legally responsible in the state of Ohio to pay for any medical coverage her insurance will not ?

 

[somarco]

Yes, and no.

When treatment is rendered SOMEONE signs a financial responsibility form. Presumably it is the one who is receiving treatment. So if your wife is treated (and is the one who signed the financial forms) and there is an outstanding balance after third party payments, then she is responsible for payment of that balance.

If she refuses to pay, collectors can come after her and any joint accounts which in turn makes you liable to the extent joint funds are shared.

Is there a reason why you dont want to pay for your wifes treatment?

 

[Timothy42]

insurance coverage

I have no problem paying if it is necessary. I am unaware what visits my wife makes to the doctor and what is covered, the costs etc. and I have never had to sign anything. The clinic filed her paperwork as having a hearing loss and was apparently not covered. She received a letter that it was denied. However, she never had a hearing loss and was never diagnosed in any way with a hearing loss. It appears to be mis-filed by the clinic and queries to the insurace company says they need to refile it correctly and it will be paid. The clinic refuses to do so. So now I get letters saying I need to pay it and I have never spoken to the people, my wife handles all her own bills etc.

 

[somarco]

I find it odd that the clinic will not refile the claim. How much money is involved?

Someone will have to pay. As indicated earlier, if the carrier denies the claim, and your wife refuses to pay, your joint funds can come in to play.

 

[Timothy42]

The amount is only $220. My wife attempted to make payments and was refused also. I suppose our only recourse will be to pay the bill and never go there, or possibly file a complaint with the local BBB. I find it odd also there is a hassle with refiling correctly.

 

[somarco]

I would suggest going back to the provider and letting them know you want them to refile the claim with proper coding.

So . . . your wife tried to pay the $220 to the provider and the provider REFUSED to accept her money, AND refused to refile????

File a complaint with the carrier, and with the local medical society. Something isn't right here. Keep a copy of all correspondence. This is really messed up. Cant imagine a provider acting in such a way.

 

[Timothy42]

insurance coverage

Thank you for your response. I probably wasn't clear about the payment, she tried to set up a payment schedule and was refused, they wanted the entire amount. I also did not hear every conversation she had so I am possibly not aware of every detail. I will attempt to return with her to the clinic to hear first hand. My first idea that there was even a problem was to receive a bill with my name on it for services I was unaware of. Hence I was wondering how involved I had to be and how liable I was. Also it seems a little difficult to find out how to proceed and I am not sure at this point if I can do anything since I am not the patient in question. As her husband I am not certain if I can see any of the medical issues or not without her present. Again none of this would be a problem except I have been caught in the end here with a bill I was unaware of.

 

[somarco]

There are privacy issues that will prevent the doc from sharing most (all?) of the information about your wife's medical history. Yes, both of you should go and settle this in person if possible.

I can understand why they want the amount paid in full . . . payments on a $220 bill are more of a hassle and they just want to get it over with. Of course much of it could be settled if they refiled the claim with proper coding . . .

Your carrier has an appeal process and this is outlined in your policy or SPD (if this is an employer plan). But it appears the issue is not with your carrier, but with the provider.

Take all of your records, including the EOB from the carrier and sit down with their billing clerk. Some providers have off-site services that handle all their claims so before going to see the doc find out who handles their coding and billing.

Before you go you might want to look up the ICD9 codes on the EOB from your carrier. Try this site http://www.medical-coding.net/sec/icd9/?path=/sec/icd9/ to see if you can get a match on the diagnosis coding. If that doesn't work, Google ICD9 lookup and you will get a list of sites that have free online searching capability. If the ICD9 on the EOB does not match what was diagnosed, there is the root of the problem.

It is possible the paper work given your wife at time of her treatment will have a different (conflicting) ICD9 code when compared to your EOB.

Hope this helps.

 

[purple2]

Somarco is right, the refusal to resubmit a claim to correct erroneous diagnosis coding is odd....unheard of, IMO. If it were me, I'd be asking them WHY they are refusing to correct the diagnosis and resubmit before I paid the bill. Is it possibly because the provider believes the diagnosis was correct in the first place?

You also have the option of paying the bill and submitting it for payment yourself to the insurer, then following the appeals process. It is going to get denied at first if the diagnosis code is not covered. However, if the documentation in the medical record is obtained by the insurer and it does not support the diagnosis originally assigned, you might win the appeal.