Patient First

[Dymphna]

Back in August, my son injured himself at a Blue Crabs game. We consulted with the EMTs there and they recommended we take him for x-rays for a possible broken nose. They offered to take him by ambulance to the hospital, but suggested it would be faster if we took him to the Patient First urgent care center in Waldorf. Since we were in 2 cars that night, huntr took him to the urgent care center and I took the rest of the family home.

It was all good, no broken bones, just a bad cut and bruise and a little scar for the rest of his life, that to a 9 year old boy, is kinda cool.

Six weeks later, I got a notice saying the insurance never paid, could I please verify that all the information on file was correct....done.

Six more weeks and I get a bill, the insurance still hasn't paid. I check with the insurance company and they have no record of a claim. I call Patient First and inform them of this and tell them to resubmit.

Two months later, another bill. Insurance company still doesn't have a record of any claim being made. I call Patient First and they say they will resubmit again.

Two months later, another bill. Insurance still has no record of the claim. After calling PF, I fax a copy of the insurance card to make sure they have all the info they need.

Six weeks later (today) another bill. Insurance company STILL has no record of the claim. Insurance company says that it is PF's responsibility to file the claim. I ask what I can do to make this go away. Insurance company calls PF and verifies that all the info is correct (which it is and always has been) and PF says they will file again.

 

[Aerogal]

Maybe you should send a copy of this post to the OWNER of PF, and then ask them when they'll have a job opening in their billing staff cause you know a high school drop out that needs a job. Obviously it would be an improvement in their billing dept.

 

[sanchezf]

I am currently going thru this myself. I think this is how they make money.

 

[Dymphna]

I am currently going thru this myself. I think this is how they make money.

They are going to spend more money on stamps and paper then they are going to get out of me.

 

[BernieP]

I am currently going thru this myself. I think this is how they make money.

The only people making money on this is maybe the insurance company since they haven't had to pay the claim? But in the end it's going to cause the provider to raise rates (to cover the expenses) which will cause the insurance company to increase fees, co-pays, and deductables.

FWIW the scenario decribed above is all to common and as the pateint you are often without recourse - except to be responsible for the bill.
As ugly as it might get, don't pay the bill until the insurance company has processed the claim.

 

[Dymphna]

As ugly as it might get, don't pay the bill until the insurance company has processed the claim.

I've already told them I wasn't paying until they got the claim processed. No one I talked to has disputed that. And FWIW, the bill is not marked as past due, just "due upon receipt."

 

[Sparx]

Call the state insurance board or similar office in MD. We had this problem in Ohio and found out there was a crook at O U Hospital playing with the books in some way embezeling funds.

 

[Nickel]

I went to that Patient First for a broken foot when I was visiting my mom last month. Guess I can expect a bill and run-around in a couple weeks?

 

[BOP]

The only people making money on this is maybe the insurance company since they haven't had to pay the claim? But in the end it's going to cause the provider to raise rates (to cover the expenses) which will cause the insurance company to increase fees, co-pays, and deductables.

FWIW the scenario decribed above is all to common and as the pateint you are often without recourse - except to be responsible for the bill.
As ugly as it might get, don't pay the bill until the insurance company has processed the claim.

We have a problem with providers, we called Aetna, they call the company and biatch slap them around (sometimes when we're on the phone!), and that resolves the problem.

 

[ginwoman]

can you send the bill to the insurance company yourself?

 

[Hoover]

Maybe you should send a copy of this post to the OWNER of PF, and then ask them when they'll have a job opening in their billing staff cause you know a high school drop out that needs a job. Obviously it would be an improvement in their billing dept.

I have been going through the exact same thing. I copied all their bills today and mailed them back with the EOB from the insurance company saying it was paid. I also received a bill for $20.60 for late payment fees which I graciously told them where they could place this bill.

 

[Dymphna]

Call the state insurance board or similar office in MD. We had this problem in Ohio and found out there was a crook at O U Hospital playing with the books in some way embezeling funds.

I don't know how someone could be stealing, no money has been paid. If the problem persists, I may have to seek a government agency.

 

[Dymphna]

can you send the bill to the insurance company yourself?

No, the won't accept it.

 

[SoMdDude]

I have used PF a handful of times now and never had any problems, was just there today ironically. I had good timing cause there were only 3 people in the lobby, I was in and out in less than 90 mins

Now that I think about it, I did have a issue similar to yours the first visit there, but got it cleared up after 2 phone calls..good luck.

 

[EmnJoe]

have them check the date of the claim. I had this and turns out the submitted with last years date and that cause those types of issues.

 

[playerhater]

Back in August, my son injured himself at a Blue Crabs game. We consulted with the EMTs there and they recommended we take him for x-rays for a possible broken nose. They offered to take him by ambulance to the hospital, but suggested it would be faster if we took him to the Patient First urgent care center in Waldorf. Since we were in 2 cars that night, huntr took him to the urgent care center and I took the rest of the family home.

It was all good, no broken bones, just a bad cut and bruise and a little scar for the rest of his life, that to a 9 year old boy, is kinda cool.

Six weeks later, I got a notice saying the insurance never paid, could I please verify that all the information on file was correct....done.

Six more weeks and I get a bill, the insurance still hasn't paid. I check with the insurance company and they have no record of a claim. I call Patient First and inform them of this and tell them to resubmit.

Two months later, another bill. Insurance company still doesn't have a record of any claim being made. I call Patient First and they say they will resubmit again.

Two months later, another bill. Insurance still has no record of the claim. After calling PF, I fax a copy of the insurance card to make sure they have all the info they need.

Six weeks later (today) another bill. Insurance company STILL has no record of the claim. Insurance company says that it is PF's responsibility to file the claim. I ask what I can do to make this go away. Insurance company calls PF and verifies that all the info is correct (which it is and always has been) and PF says they will file again.

That is ridiculous, I surely would got to PF and see this so called claim paper they filed in person.

 

[NewMotherOf1]

We consulted with the EMTs there and they recommended we take him for x-rays for a possible broken nose. They offered to take him by ambulance to the hospital, but suggested it would be faster if we took him to the Patient First urgent care center in Waldorf.

As someone in the EMS field this kinda pisses me off. Sorry this isn't about your problem with patient first. Those EMT's should not have told you to take your son there. If they were at my station they'd get into a whole lot of trouble.

 

[sweetprincess23]

No, the won't accept it.

What they probably won't except is your billing statement from PF because it does not list everything they need to process a claim, i.e. cpt codes, dx codes, units, etc.
I am not sure who your insurance company is but.... call PF and request a copy of the Hcfa 1500 form or UB94, probably a hcfa 1500 form since it was a urgent care. This is the actual claim form that providers send to the insurance company. Then once you get the form, call your insurance and ask for a fax number or the billing address(which should also be on the back of your card) and send it to the insurance company. They will never know who sent it and keep a copy for yourself, that way you know it got sent.

btw, i work for an insurance company. It happens all the time especially if they are sent electronically which most are these days. As everyone should know, electronic does not mean perfect. Claims get lost over the server, in the mail or whatever. Also, check your timely filing limit because if it gets to late that is another reason for the insurance company to not pay. But you can appeal timely filing.

 

[huntr1]

As someone in the EMS field this kinda pisses me off. Sorry this isn't about your problem with patient first. Those EMT's should not have told you to take your son there. If they were at my station they'd get into a whole lot of trouble.

Why?

 

[OldHillcrestGuy]

As someone in the EMS field this kinda pisses me off. Sorry this isn't about your problem with patient first. Those EMT's should not have told you to take your son there. If they were at my station they'd get into a whole lot of trouble.

Yes why. :shrug: If this was Charles and it was a career staff, they just saved them $360 for a ambulance ride to the hospital.