Medical Bills with Insurance Switch

[alotofyarn]

The hospital switched from Humana to BCBS in January. The plans are mostly the same. However, some bills are trickling in from last year, and they're being billed to the new insurance. How does this work?

My biggest concern is that I'm pretty sure we met our OOP max last year, or at least we should have, especially if they had billed us everything they were supposed to. So, we just got a bill from one of the ED visits, and we didn't pay the co-pay at the time because we shouldn't have needed to. One of the changes with the new plan is an increase in that co-pay.

[metroguy]

you should call the hospital billing dept and ask.. they probably need to send it to the right insurance co.. it's one big pain..

[alotofyarn]

you should call the hospital billing dept and ask.. they probably need to send it to the right insurance co.. it's one big pain..

Ugh. We haven't even gotten a bill. The new insurance company sent something today asking if we had other coverage, and it said it was billed for January, but really it was an older visit.

[OrionGrad]

I had my melanoma surgery on December 30th a few years back, and I think all the bills except 1 got billed for the correct year. For the 1 bill that snuck through, we started with the hospital billing department but ultimately had to get insurance involved to sort it out. (We were on a different fellowship insurance by the time the last bill came, which sort of compounded the issue.) I hope you get it all sorted out soon. I'm sure you've become an expert on this stuff since C was born.

[HouseofWool]

Metroguy is right, the service needs to be bill to the company that was in effect on the date of service. I would start with the hospital billing department to get it straightened out.

[alotofyarn]

So, I think most of it has been handled, except there is one big issue. C has been getting Synagis to prevent against RSV. When we started in November, we got it approved through Humana. I asked both the pharmacy and the pulmonology nurse if we needed to do a new prior authorization since we were switching to BCBS, and they both told me it would be covered. Fast forward to now, and BCBS denied the one he got in January, meaning they'll also deny the one from February, as soon as it's processed. These are $5k shots. He's got one more scheduled for the end of March. I called BCBS, and they said they don't do retroactive prior authorizations, I just have to appeal the denial. So, I wrote up my appeal letter and will get that in soon. I also left a message with pulmonology asking them to submit a prior authorization before his next one, because I don't want to have to do this again. Such a pain. I thought we were over all of this insurance mess.

[SoonerTexan]

What a pain in the ass

[Thirteen]

I, too, am experiencing the shitshow that is auth with BCBS.
I am seeing you a hug, and the patience to endure.


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[alotofyarn]

The pulmonology nurse messaged me on Monday and said this shouldn't be the case at all, and they'd do everything they could to help me fix it.

The pharmacy that fills the shot called me today and said they had taken care of it, that they talked to BCBS and were able to get a retroactive preauthorization for the two shots he's gotten already this year, and they'd make sure it was approved before they filled the final one for this month.

Every once in a while you get amazing customer service, and it's so nice!