5 On Your Side

Raleigh man fights 'frustrating' medical billing mistake

Posted May 19, 2010 5:00 p.m. EDT
Updated May 19, 2010 6:30 p.m. EDT

— Have you had to decipher a medical bill lately? If so, you know how difficult it can be to figure out if it's accurate. A Raleigh man found a mistake on a bill but could not get it fixed, so he called 5 On Your Side's Monica Laliberte.

Most insurance companies send what's called an Explanation of Benefits. It shows the amount insurance covers, what you've already paid and the uncovered amount you do not owe. That's because of a negotiated contract between the insurance company and the provider.

But a lab kept trying to get Cecil Raynor to pay.

“Every year on my birthday month, I go for an annual physical,” he said.

As part of his physical last June, Raynor had blood tests. Spectrum Labs did the analysis. Raynor's insurance provider, United Health Care, covered all but $220.

As part of the contract between United and Spectrum, Raynor did not have to pay that difference. But a month later, Spectrum billed Raynor for it. A call to United confirmed he didn't owe it.

“I assumed at this time that the paperwork has not caught up through the system,” Raynor said.

But Spectrum just kept sending bills. Raynor kept calling and said each time he was told his case would be reviewed. Then, his bill went to collections. He asked United to intervene, and they sent Spectrum this letter:

“Our records indicate that you sent a bill to Cecil Raynor. This amount is above your contracted fee and it is not the enrollee's liability. Please adjust your records so our enrollee will not be billed for this balance.”

The next week, Raynor got another bill, then a threatening call from an attorney.

“I don't know if it's standard routine with them or not, but it certainly has been a frustrating effort for me,” he said.

Five On Your Side called both companies, and they agreed to look into it. Spectrum then sent Raynor a letter saying they "discovered a system error" that resulted in an "erroneous bill."

Raynor said he wonders how often it happens and how many people simply pay the bill.

“I assure you my mother-in-law or my mother, had they received a bill like this, it would have been paid the next week with no questions whether it was a valid bill or not,” he said.

Neither Spectrum nor United would talk with 5 On Your Side about the error or even say how it happened. Both cited privacy laws, which often make it difficult for 5 On Your Side to get involved in insurance disputes.

Another option for consumers is to contact the North Carolina Department of Insurance’s consumer complaint division.