Haven’t received lab bill - should I call?

[theophan]

Background: Went to get my annual STD check done 9/16. (All negative). My primary and secondary are both blue cross blue shield but different entities. Primary kicked back and said denied - coding issue. Secondary followed two weeks later and said denied - coding issue. They both wanted my medical record provided.

The initial claims were for the urgent care visit + lab testing through Avalon.

Both show denied - $300 urgent care $950 Avalon lab testing.

Fast forward a few weeks after, I called the office manager and explained I needed that bill to be recoded as it was initially coded as preventative instead of diagnostic (had a rash thought was an STD). She didn’t understand and hung up on me (literally).

Balance still showed $0.00 on website so I called and spoke to a patient billing rep who got back to me a week later and stated it’ll be rebilled.

Both insurances processed the urgent care rebill properly.

I was never rebilled for the denied lab bill of $950. I haven’t received a bill either. And of course google isn’t helpful for finding a phone number to call Avalon.

It’s been over 3 months now. Should I just ignore it or will eventually I receive a bill? I just don’t want to be sent to collections for not receiving a lab bill.

For context, this urgent care is part of one of the biggest hospital systems in the state. And this lab does all their lab work.

 

[mountaintrip98]

@theophan What does the EOB show you owe? If it was a coding issue it's possible it was denied as provider liability and the burden is on the providers to fix their boo-boo if they want to get paid.

 

[theophan]

@mountaintrip98 EOB for lab says I owe $0.00 and the claim must be resubmitted properly.

 

[resjudicata]

@theophan Have you received an EOB yet after it was resubmitted to fix the coding issue? If not, I wouldn't be overly concerned quite yet.

It is provider responsibility to submit a properly coded claim that can process within a 6 month period (some, though not many, are a year). If they can't then they should be writing the costs off for not meeting timely filing guidelines.

If they refuse to for some reason, file a grievance and appeal with your insurance. They'll change their tune pretty quick.

 

[theophan]

@resjudicata I received a letter from both insurances that state something along the lines of “don’t worry - we are working on this claim”. That was for the $300 urgent care when it was originally denied.

For the lab, EOBs on the app show both as denied owing $0.00. Nothing provided or mailed to me

 

[resjudicata]

@theophan Yeah, definitely don't worry about it then. If the EOB shows $0 patient responsibility, if they are in network they cannot even attempt to hold you accountable for the cost. If they try, file an appeal with both BCBS groups you have. It is provider responsibility to submit a claim that can properly process within timely filing guidelines. If they can't fix the issue, its on them.

Moreso than that, you have two insurances. It's very unlikely that even if they fix it that you'll get a bill. If you do, it should be very minimal.