Newspaper article The Record (Bergen County, NJ)

Call to State Agency Solves Insurance Problem

Newspaper article The Record (Bergen County, NJ)

Call to State Agency Solves Insurance Problem

Article excerpt

Please help us, the Rutherford woman asked.

Back in July, her husband was rushed to Hackensack University Medical Center's cardiac unit to clear up a blocked heart stent. Everything went fine in the OR; the problem was with the insurance company.

The doctor who handled the emergency was not in network for Horizon Blue Cross Blue Shield of New Jersey, so the patient signed an Assignment of Benefits form and endorsed the check over to the doctor when it arrived.

But six months later, "we get a letter from BC/BS saying that they overpaid and they want us to pay $4,949.77 back to them," Nanda Bhatia said. They were given 45 days to pay up or have the money, plus interest, deducted from future claims.

Why should we have to pay it back, Bhatia asked. "I do not work in the accounting department of BC/BS. I did not write the check. The mistake was made by their accounting department. Why are they holding my spouse and me responsible for their mistake??

"Please help!!"

I suggested that she contact the New Jersey Department of Banking and Insurance, which oversees the insurance industry, through its toll-free consumer hotline, 800-446-7467, or on the Web at state.nj.us/dobi/consumer.htm.

And that seems to have worked.

"I followed your suggestion, Arun Bhatia said. "We bombarded them online."

And on Tuesday, the Bhatias got a call from Horizon saying it would try to get the money back from the doctor.

While he said he could not answer specifics of this case, Banking and Insurance spokesman Ed Rogan agreed that consumers with billing questions should get his department involved.

When they do, "we will ask the insurance carrier to stop the clock on the insurance process," Rogan said. Overpayments could be the result of "all kinds of things," including a mistake on the carrier's part. Also, the department might be able to work out a deal, to get the insurance company to cut consumers some slack, he said.

Remember: Hospital and doctor bills are negotiable, as the amount billed often has little relationship to what is actually paid. …

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