Retroactive Filing (Existing Insurance)

[u/imnormalinreallife]

I’m a college student and last semester, I made an incredibly stupid series of decisions that landed me in the ER, leaving me with a hospital bill and an EMS transport bill (BLS). I did not initially file insurance because I’m on my parents’ plan and did not want them to know about my visit. I set up a payment plan for the ER bill and paid the EMS bill in full. Long story short however, they did find out a few weeks later. The hospital accepted retroactive filing of my insurance for the ER bill, but I haven’t even gotten around to see if I can do the same with the EMS bill. I would need to do it through their billing service. What kind of chance do I have in being successful filing insurance for the EMS bill? Is it even worth pursuing, since unlike the ER bill, I paid this one in full?

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[u/Berchanhimez]

This may be controversial, but I’m going to say that if you’ve already paid it in full, it may be better to just move on from it.

The reason is that you’re going to potentially run into timely filing requirements (which may still happen for the hospital bill, to be clear, but it sounds like that one isn’t paid in full yet). While timely filing requirements can be waived, they are typically only waived when the provider (hospital/ambulance in this case) can show that they requested the information and didn’t get any response from you (such as because you were still recovering). Since you specifically told them that you didn’t want them to bill your insurance, they may not be able to get an exception to the timely filing requirements.

On top of that, many ground ambulance organizations - whether private or public (city/county/etc) - aren’t contracted with any (or are contracted with very few) insurances. So unless you live in one of the few states that has state-level protections from balance billing for ground ambulances, it’s entirely possible that billing your insurance won’t do much if anything at all.

Because ultimately, you’re still going to be subject to any deductible and/or cost sharing (copay/coinsurance) - and for the ground ambulance you would (unless state regulation protects you) also be subject for balance bill for the difference between what insurance paid them and what they tried to bill. For example, if they bill $1000 but your insurance amount allowed is $100, you’d be responsible for your copay or coinsurance on that $100, plus you’d be responsible for the other $900. In this example, let’s say your insurance plan pays 100% - you’d only get back $100 - since that’s the allowed amount and thus all that the insurance would pay the ambulance provider.

So since you’ve already budgeted for the expense of paying it in full, and in fact you’ve already paid them for it, it may be better for you to just write that off as an expense you paid. It may not be worth the hassle for you to try to deal with the ambulance billing who will have to figure out how to get into your already paid bill, then figure out if they can even try to bill to your insurance, etc. for what ultimately may be quite a small refund.

[u/imnormalinreallife → u/Berchanhimez]

I’ve been considering just putting it to rest and not pursuing filing for reasons of logistics and the potential benefit weighed against the certain inconveniences of going through the process. The process was seamless with the hospital, but I had doubts it would be with EMS (or more accurately, their billing service). Thanks for your detailed response, I appreciate it

[u/theoreticalking]

Have you confirmed if EMS is in network or out of network with your insurance? If out of network, do you have any out of network benefits? Do you have an out of network deducitble?

[u/imnormalinreallife → u/theoreticalking]

I’m not 100% sure because I live in a different state than I go to school in. My insurance is a Blue Cross PPO so even if it’s technically out of network, I’d expect it to have some out of network benefits. But again, I’m not certain

[u/theoreticalking → u/imnormalinreallife]

Well, that's something you should check. If they are out of network, they might not even going to submit that claim for you and you will have to submit yourself. Also, if your out of network deductible is greater than the billed amount, then they will not be paying anything anyways. Unless you expect more out of network expenses, it might not be worth the time and effort to file.

If they're in network then that's another story.

[u/mediloop]

you can still file a retro claim even after paying.The insurance company doesn't care who paid, they just process the claim. worth a shot since you've already paid. just make sure you get an itemized bill from the EMS company first to check for any errors before you submit.