We live in Tennessee. My son had TennCare, but he lost it on September 23. He had a sleep study on September 15. We told the sleep center many times that his insurance was ending, and they even moved his sleep study up because of that. Yesterday, I got a text saying his bill was ready. I called to find out what it was for and learned that the doctor didn’t read the sleep study until October 3, so it wasn’t billed to the insurance since he didn’t have coverage then. I spoke with the sleep center several times, and they never mentioned we might be responsible for any costs if the study wasn’t read in time. This is frustrating, and now they say we owe over $200. They said they would try to bill the insurance with an explanation, but they aren’t hopeful about it. What can I do? I don’t think we should be responsible since they knew his insurance was ending.
I can’t comment on sleep studies, but for my providers, they interpret OB ultrasounds days after they’re done, and the service date is always the date of the ultrasound, not the date they read it. The service date isn’t the same as the reading date.
You might want to ask the doctor’s office to confirm they submitted it with the correct date. There could have been a mistake.
The lady I talked to said it would be fraud to change the date. The way she talked it’s billed separately. That doesn’t really make sense to me, but they have been involving supervisors supposedly so surely they are giving me accurate information, but who knows.
She’s mistaken.
Billing errors related to the date of service happen frequently. Providers can submit a corrected claim with the necessary documentation to the insurance company to change the date of service.
If the sleep study date is wrong and should reflect the actual date it was performed, the provider can create an addendum to fix the date in the documentation.
While I’m not an expert on sleep studies, it seems like this process should be similar to how radiology services are reported. The date of service for an X-ray is always the date it was performed, not when the radiologist reads it.
Thank you. That makes complete sense to me, but she didn’t seem to agree. I will call them back tomorrow.
Every time I fet a CT scan, the radiologist reading report uses date if CT scan.
Are you sure his Medicaid ended on the 23rd? In my state, the disenrollment date is the last day of the month.
100% sure as that’s what TennCare said in their letter and in the portal. It said terminated and that was the end date.
Have you reached out to TennCare? They should be handing the interaction with you and the sleep clinic. Ultimately, unless he signed a form allowing them to bill him for services, he should not be obligated to pay anything as a Medicaid member at the time of service.
I haven’t yet. I will do that. To my knowledge nothing like that was signed. They never even mentioned the possibility that this could happen. They didn’t talk about payment at all.
As frustrating as it is, the provider did deliver a service while caring for your son. They deserve to be compensated for their work, even if the situation is difficult. It’s not solely the provider’s fault.