Macon, GA asked in Health Care Law and Insurance Bad Faith for Georgia

Q: Can a hospital billing office refuse to contact an insurance company directly over a problem with the claim?

So my father had surgery in March to reverse is ileostomy, and the insurance company says that the provider listed on the claim was incorrect. They want the hospital billing office to contact them directly. However, the billing office simply says "we don't do that". So we are stuck in this loop where the insurance is saying there is something wrong with the claim, and the billing office refuses to cooperate at all. What should we do in this situation?

1 Lawyer Answer
Tim Akpinar
Tim Akpinar
  • Insurance Claims Lawyer
  • Little Neck, NY

A: A Georgia attorney could answer best, but your post remains open for three weeks. Until you are able to consult with a local attorney, one of the things you could look into is the correct information for the provider. Although any large hospital has its inhouse billing/collection operations, there are often many separate entities that bill independently of the hospital itself even though its medical personnel work in the hospital. In many instances, specialists in surgery, radiology, and other disciplines bill under names such as "physician's billing," "radiology billing," etc. It's possible lining up the proper billing entity with the correct claim rep might be helpful. Move quickly - depending on the carrier and the type of insurance, there could be deadlines within which to submit bills and avoid timeliness-based denials. Good luck

Tim Akpinar

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