Topic: Insurance/billing question

Forum: Employment, Insurance, and Other Financial Issues — Employment, insurance, and financial concerns are common. Meet others here to discuss and for support.

Posted on: Jul 18, 2017 12:33PM

Posted on: Jul 18, 2017 12:33PM

lovepugs77 wrote:

I got a bill in the mail yesterday from the pathologist for the surgery I had on March 28. They were in-network with my insurance. Since I've already met my deductible and out-of-pocket max for the year, I pulled the EOB. In the "Amount Your Provider May Bill You" section, it says $0 . Copayment, deductible, coinsurance, other liability and total each say $0. I thought that meant they couldn't send me a bill...am I confused?

DX at age 39 Dx 2/17/2017, IDC, Left, 2cm, Stage IIIA, Grade 2, 4/24 nodes, ER+/PR+, HER2- Dx 2/17/2017, DCIS, Right, Stage 0, Grade 3, ER+/PR+, HER2- Surgery 3/28/2017 Lumpectomy; Lumpectomy (Left); Lumpectomy (Right); Lymph node removal Surgery 4/13/2017 Lymph node removal; Lymph node removal (Left) Chemotherapy 5/18/2017 AC + T (Taxol) Radiation Therapy 9/27/2017 Whole breast: Breast, Lymph nodes Hormonal Therapy 11/15/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
Log in to post a reply

Page 1 of 1 (5 results)

Log in to post a reply

Jul 18, 2017 12:52PM - edited Jul 18, 2017 12:54PM by Goincrzy8

Had you met all that before the DOS? Do you have the EOB from the insurance for that bill showing 0 amount due? If the eob from insurance is for that bill, call them, someone made a mistake and probably did not write of the contractual adjustment.

I am not sick, I have a few bad cells Dx 10/18/2016, IDC, Left, Grade 2, 12/12 nodes, ER+/PR+, HER2- Surgery 12/9/2016 Mastectomy: Left
Log in to post a reply

Jul 18, 2017 12:56PM - edited Jul 18, 2017 12:57PM by lovepugs77

I met all of that on the day of service (March 28). My surgeon's office required a pre-payment three days before the surgery that met my out of pocket max for the year. Yes, I have the EOB from the insurance company, and it shows $0 due. This bill from the pathology office is dated July 11, so they should have been able to easily see that I have met my out of pocket max.

The bill shows an Insurance Payment as well as an Insurance Adjustment. The charge is for the difference between those and the total.

DX at age 39 Dx 2/17/2017, IDC, Left, 2cm, Stage IIIA, Grade 2, 4/24 nodes, ER+/PR+, HER2- Dx 2/17/2017, DCIS, Right, Stage 0, Grade 3, ER+/PR+, HER2- Surgery 3/28/2017 Lumpectomy; Lumpectomy (Left); Lumpectomy (Right); Lymph node removal Surgery 4/13/2017 Lymph node removal; Lymph node removal (Left) Chemotherapy 5/18/2017 AC + T (Taxol) Radiation Therapy 9/27/2017 Whole breast: Breast, Lymph nodes Hormonal Therapy 11/15/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
Log in to post a reply

Jul 18, 2017 01:15PM - edited Jul 18, 2017 01:22PM by dodgersgirl

lovepugs77- call your insurance company. They should handle this. I had a similar issue where the EOB showed what insurance was liable for and what was over the agreed amount since my med bill was in-network. The place doing the service believes they are still owed nearly $900 and when insurance didn't pay it, they billed me which is against the contract between med office in network and insurance. Insurance Co told med office to resubmit using different DX code if they thought insurance should have paid and it would be processed again. My insurance Co told me to call the Insurance Co only when dealing with this bill as the issue is about the contract between insurance co and provider. (Assuming your provider of services is in network

Dx 3/10/2017, IDC: Mucinous, Right, Stage IIIB, Grade 2, ER+/PR+, HER2- Surgery 9/11/2017 Mastectomy; Mastectomy (Right) Dx 12/2019, IDC, Right, Stage IV, metastasized to bone Radiation Therapy Whole breast: Breast, Lymph nodes, Chest wall Chemotherapy AC + T (Taxol) Hormonal Therapy Arimidex (anastrozole)
Log in to post a reply

Jul 18, 2017 01:15PM - edited Jul 18, 2017 02:45PM by Goincrzy8

I would call the office and explain it to them. We need to be our own advocates. I work in a medical office and if your EOB states 0 they dont know how to read an EOB :(


I am not sick, I have a few bad cells Dx 10/18/2016, IDC, Left, Grade 2, 12/12 nodes, ER+/PR+, HER2- Surgery 12/9/2016 Mastectomy: Left
Log in to post a reply

Jul 18, 2017 01:44PM gb2115 wrote:

I had met my out of pocket and still got billed for an office visit with my MO. A quick call to their billing office resolved it. I would call the provider!

First Dx IDC in 10/16 at age 38, stage 2A, 1.2 cm ER/PR+ Her2-, Grade 2, 1/3 nodes. Lumpectomy + radiation + tamoxifen. Second Dx IDC recurrence in original location 5/21. 1.3 cm ER/PR+, Her2 -. Grade 2. 2/2 nodes. UMX + AC/T + Zoladex/Exemestane + Zometa.

Page 1 of 1 (5 results)

Scroll to top button