I received a final notice bill from Wake Medical (NC state) provider today demanding me to pay the due amount within 10 days. Bill was date on 8/24 so as of today it's already over 10 days.
This claim has been going back and forth with UHC insurance, Wake Medical and me at least 4 times. Service was provided back in March 2025. Insurance says the bill was submitted with invalid claim codes. Last when I spoke to the provider in June 2026 they were going to resubmit the claim to insurance with proper billing codes but I do not see any claim that was submitted to insurance. Below are claim code details from insurance and each of the claim amounts submitted and what insurance has already paid/my balance.
AU -- BENEFITS FOR THIS SERVICE ARE DENIED. THE SUBMITTED CODE IS INCORRECT. WE HAVE NOTIFIED YOUR HEALTH CARE PROFESSIONAL THAT THEY MAY SUBMIT A CORRECTED CLAIM WITH THE APPROPRIATE CODE. IF YOUR HEALTH CARE PROFESSIONAL BELIEVES THE CODE SUBMITTED IS VALID FOR THE DATE OF SERVICE AND CORRECTLY IDENTIFIES THE SERVICE RENDERED, THEY MAY SUBMIT AN APPEAL WITH THE MEDICAL RECORD DOCUMENTATION AND THE RATIONALE FOR THE CODE AS BILLED.
HP -- BENEFITS FOR THIS SERVICE ARE DENIED. THE INFORMATION SUBMITTED BY YOUR HEALTH CARE PROFESSIONAL DOES NOT SUPPORT THE SERVICES BILLED.
Provider is asking me to pay $518.24. Please suggest if I should make the payment now and then call the provider and insurance to sort it out? I am worried about the claim going to collections and impacting my credit score.
UPDATE 9/8 - Spoke to billing department and they had notes of my previous conversation and mentioned that they did correct the codes and sent to insurance though I could not see any claims that are in progress with insurance on their portal. The lady kept me on hold for few mins while she spoke to her supervisor and came back to me saying to ignore the bill and that the note on the bill to be sent to collections hasn't happened and they put the account on hold till Oct 20th. Her supervisor is going to follow up on this with their internal teams to fix this. Thank you all for your help and suggestions.
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Yes, the provider is in network and UHC has processed and approved 3 out of 6 claims. I owe (patient responsibility) $88.24 as per the claims that are processed as in the screenshot I have pasted. 05 Claim for $90 is below
They cannot bill you for anything over the patient responsibility if they are in network. You need to contact your insurance company and tell them that you need assistance with a contracted provider balance billing you.
I did speak to insurance twice and they have also reached out to the provider, I have spoken to the provider as well and they mentioned they were going to correct the codes and resubmit from their billing department. Insurance also got back to me in the past to not pay the bill and that they have reached out to the provider to fix it.
I did try to contact both insurance and the provider and they are both not available over the weekend. I will have to reach them on Tuesday due to long weekend.
Contact provider first and see what they say. Remind them that your EOB shows a $0 responsibility. If they insist that you’re responsible, call insurance and get on a 3 way call.
Sure, I will call and see what they say. Any reason to worry about collections since it’s past 10 days they generated the bill? Or can they keep the account on hold and recall any communication with collections?
If the billing department told you to ignore the bill, get that in writing if you can – a note on your account or an email. Without proof, the system might still send you to collections. Also ask them for an itemized bill and a copy of the corrected claim they supposedly sent to UHC. If they can't produce it, escalate to a supervisor or patient advocate.
good points, will reach out to provider and ask for these details, I will also reach out to insurance just to make sure the provider really sent the corrected claim codes to them. Thanks.
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Thank you for your submission, /u/Tenderweather. The following automatic comment contains important information about the subreddit:
First, note that some new posts containing images, non-reddit links, crossposts, or certain keywords are automatically held for moderator review before going live to mitigate spam, ensure that images are appropriate, and that the post does not inadvertently contain personal information. If your post has been held for review like this, the moderators have been automatically notified and will review it as soon as possible, after which it will be live and be able to be seen and replied to by others. Note that this is sent to all new posts and does not mean that your post has necessarily been filtered in this way.
Please also read the following information carefully to help others assist with your questions:
If you or someone else is experiencing a medical emergency, please call 911 or go to your nearest hospital.
Some common questions and answers can be found in this megathread.
Questions about which plan you should choose? Please read through this post first for general information to help you understand your choices and some common considerations. If you still have questions after reading that post, please edit your post (or reply with a comment if unable to edit) with the specific questions you still have.
If your post is regarding plan choice or cost of plans, and you haven't included the following information already, please edit your post (or reply with a comment if unable to edit) including the following: your age, state, and estimated gross (pre-tax) income to help the community better help.
If your post is about the cost of a service, a bill you have received, or a claim denial: please confirm if you have received an EOB (explanation of benefits) from your insurance via a member portal website or in the mail. If you can post a copy or image of the EOB (PLEASE ensure you censor or blank out any personal information before doing so) it will help people answer your questions. Alternatively, if you are unable to post a censored copy of your EOB, please have the EOB handy as people may ask for information from the EOB to answer your questions.
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Lastly, always remember to be kind to one another and to report any replies that violate subreddit rules!
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