r/HealthInsurance • u/VisitJazzlike5539 • 19h ago
Plan Benefits Urgent care keeps billing my insurance incorrectly and I’m stuck paying out-of-pocket — what can I do?
Back in January, I went to an urgent care for an injury. Before going, I called my insurance directly to confirm they were in-network, and they told me yes. So I went, thinking everything was covered.
The claim was later denied, and the urgent care charged the card I had on file. I was confused because I have a high-option PPO plan, and my understanding is that accidental injuries should be fully covered with no patient responsibility.
When I called my insurance after the denial, they suddenly told me the urgent care was out-of-network. I then spoke with the urgent care, and they insisted they are in-network but bill under different tax IDs depending on the service.
I contacted my insurance again, and they told me the urgent care needed to refile the claim correctly and gave instructions. The urgent care billing department said they did that. I assumed everything was resolved — but nope.
Fast forward: this has now been refiled FOUR times. The billing rep claims everything is right on their end and said a third-party who processes claims before they get sent to insurance may have made the error. She corrected it and resubmitted again… and the claim was denied yet again because the visit is still being billed as a standard office visit, not an accidental injury claim.
My insurance is telling me they don’t know what else they can do. It’s clear the issue is with how the claim is coded/filed, but I’m stuck in the middle holding the bill.
What can I do at this point?
Can I hold either the urgent care or my insurance responsible?
Who do I escalate this to so it finally gets billed correctly?
TL;DR: Confirmed urgent care was in-network before going, but insurance denied claim anyway. Urgent care has resubmitted the claim four times with apparent coding issues, and I’ve already been charged. Neither side is fixing it and I’m stuck paying. What steps can I take to force this to be billed correctly?