Question

Has anyone had lots of problems with insurance not paying bills from Rush-Copley ER because the provider didn't submit any supporting documentation to prove that they did anything? We have like 6 different claims that our insurance is fully denying, and we are being charged for the whole thing out of pocket, because the out-of-network emergency physician group that treated me (Aurora Emergency Physicians) didn't send any proof of service to our insurance. Ins has a negotiator company that we've gone through to no avail, because the provider refuses to budge. And more claims from months ago keep showing up, so we are on the hook for more and more money that our insurance would gladly pay if only the doctors would send over sufficient documentation! For the record, I kept being told by nurses at my doctor's office to go to the ER for a mystery condition that I later found out didn't even require it :( they contradicted my doctor in some circumstances, but I am not one to disobey medical professionals. And now they billed everything wrong, and we can't fix it. Has anything like this ever happened at Copley to anyone else, and were you able to resolve it?  

Answer 1

I know they have you sign forms while in the ER when they register you starting that some Doctors my not be contracted with them.  

Comments

That's not the point though-my insurance would still pay 100% if they would only send over documentation proving that they actually treated me; they refuse to send it

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I’m not sure on how it’s billed. Who/what’s not submitting? Can you submit the bills to your insurance company that way?  

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@pamplona this is what I have from the issue I had in 2016 and had it taken care of.  

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Bills have been submitted to insurance multiple times. They deny it because the docs aren't sending any records that they did stuff. Docs: We treated this person with X, Y, and Z procedures, now pay us Insurance: Ok, can you give us some proof that you did any of those things? Docs: Nope, just give us money Insurance: Well, then no!  

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@pamplona really. I’d call patient advocate department and explain and tell them If you don’t get anywhere, you’ll Contact the media outlets. I’m not a fan of Rush Copley’s to start with. Good luck. We use Edwards, and live 2 blocks from Copley.  

Answer 2

Yes , I’m dealing with this now

Comments

Same hospital/group?  

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Same hospital

Answer 3

Request your medical records and appeal them yourself or call and ask for a patient advocate.  

Comments

I have done the patient advocate through a third party and gotten nowhere

Answer 4

This happened to me with another hospital. You have to get your medical records and mail or fax them, whichever your insurance says, to your insurance company with the appeal letter they sent you.  

Comments

Actually I'm not sure that I mailed it to the insurance company. I may have sent it to whatever company sent the appeal letter. It was a pain. Originally they wanted the er dr to call the insurance company and I knew that wasn't going to happen.  

Answer 5

Super frustrating and quite frankly, bizarre to me that they wouldn’t advocate better with the insurance company?! I don’t know medical, but I know dental and I can’t imagine they are super different. the hospital can’t legally withhold your record. If you request it, you should be able to send the clinical notes to the insurance company which it sounds like is all they would need to see. I would recommend calling the insurance and asking where to send an appeal (get as many forms as you can: fax, email, mailing addy) and make copies of your records (retain a copy for yourself) and send it every way you can. Give it a week and then call back to ensure they’ve received it and it is under review. I know it sounds excessive. but when it comes to insurance (esp appeals or providing more info) they magically “lose” things or have “no record on file” all the time. Best of luck!