Family Gets Help With Medical Billing Error

Anyone who's ever argued with their health insurance program over the denial of a claim knows it can be a tough fight.

By: Dianne Derby | WSPA-TV
Published: January 06, 2009

As a new Medicare enrollee Deanna Rollings' plan outlined that certain exams were covered through the health insurance program. So when she had a pelvic exam with the Mary Black Physicians Group in August she didn't think twice that it wouldn't be paid. But last month she got a statement from Medicare saying they wouldn't cover the costs since it wasn't billed properly.

"Medicare said the coding had been wrong and gave me the proper code," said Rollings. "I again called (Mary Black) and gave them the proper code and they said they did not code like that."

Mrs. Rollings says she and her husband, James, spent hours on the phone and in person trying to get it fixed. That quickly changed once we got word of her problem.

"They realized after you contacted them that there was a problem that should have been taken care of," said Mr. Rollings.

Mrs. Rollings said they started getting phone calls within 24 hours of our contact with Mary Black.

"We received a call saying that it would be paid for," she said.

Mary Black Heath System Chief Development Officer Dennis Jankowski says a data entry error was the cause of the problem. He admitted they took too long to contact Medicare to get it resolved.

"We change our billers and coders every so often and we try and spot check through auditing but this one got through," said Jankowski. "Because it went through such a long time we decided we didn't want to hurt the patient any more than that so we just wrote it off."

Jankowski says MBHS has learned from this mistake and will use it as an example during future training sessions with staff.

"We hope that people understand that sometimes mistakes happen and we're glad to say we took care of it," he said.

Now Mr. and Mrs. Rollings can rest easier knowing the problem they've waited months to solve was solved nearly overnight.

If you have a medical billing problem there are state agencies that can help. In South Carolina call the Department of Consumer Affairs at 800-922-1594. In North Carolina call the Department of Justice at 919-716-6400.