Maryland | Insurance Law
Legal Question
health insurance billing
2005 school sport's injury resulting in surgery; anesthesia provider's billing company is suing for pymt even though we had both primary Blue Cross & a secondary school accident policy. Blue Cross states the provider did not submit a claim at all. The provider did submit a claim to the secondary insurer but before the primary so the 2nd co sent an EOB informing provider they needed to send a denial EOB by the primary with their claim (so there's no double payment). After receiving the court docs demanding money, we investigated & found out that the provider billed the wrong primary insurance (in spite of getting the correct insurance info and ID# from the hospital admittance- all other providers including the hospital were all paid by Blue Cross based on the admit ins data), never submitted a follow up claim to the 2nd co with the wrong insurer's EOB denial which would have yielded corrective action and payment by one or the other insurance companies. What is the provider's responsibility in submitting accurate and timely claims? if they billed the primary incorrectly & didn't follow up w/ the 2nd, shouldn't it be a provider write-off? is there any circumstance where I would still have liability since they didn't bill properly?
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Read More Answered By: G. Joseph Holthaus III |
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