Is It A Scam?

Back in December, I had an eye infection (which scared me but turned out to be easily treatable).  My medical provider was unable to see me for several days. Unwilling to wait,  I went to an urgent care, signed in with all the paperwork in the land, saw a Nurse Practitioner, got ointment, felt better.

Periodically, reminders to address the bill appeared in my inbox.  In order to access the bill I needed entry to their patient portal.  There was no reason for me to set one up; this was a one time visit, never to be repeated (the NP scared me before she looked at me more closely).  By December 2024 I had met all my deductibles.  It was up to Medicare and BlueCross/BlueShield to sort it out and send the funds on their way.

Last week I got a letter in the mail.  It was a bill for $350.  It said that BC/BS claimed I was not covered under their plan.  If this information was incorrect (it was) I was to call my insurer.  I made the call.  The lovely lady (who answered the phone after barely 10 seconds on hold) checked everywhere she could possibly check and reported that she had no claims filed for me from that provider or from any provider on that date (or, for that matter, in December at all).

Hmmm..... we said at the same time.  How could this be?  The receptionist scanned all my documents (I watched her; she had my drivers' license and I wasn't letting it out of my sight) and BC/BS agreed that the numbers I had were the same numbers they had.  

I said that I'd been calling the number on the Hi, your balance is due notice for three days.  I never spoke to a human (after 10 minutes on hold I had the option of leaving a call back number.... three times).  She suggested calling the provider's office.  We agreed that they, at least, would answer the phone.

Stefanie answered on the third ring.  She listened and (after some confusion over whether I wanted the NP herself) looked up my record.  Yes, I was in the system.  No, there was nothing owed to them on her end.  Yes, the bill was from before they merged (from Carbon Health into Northwest Urgent Care).  

She didn't know anything more, but she knew someone who did.  Five minutes later she called me back; her colleague suggested she check the numbers.  We did.  They bore no resemblance to my Medicare number.  My BC/BS number was accurate.

While she entered the correct information (I'm gonna fix this for you) we parsed the issue.  How could BC/BS notify them that I wasn't covered under their plan when BC/BS has no record of any contact at all (remember, those numbers were correct)?   I read her the verbiage on the bill.  She agreed that BC/BS indicated this service was ineligible to be covered on 5/12/25 had little basis in fact, given (a)that this is eligible under every Medicare and BC/BS plan for someone my age, and (b) BC/BS has no information at all about this claim and (certainly and obviously) no record of rejecting the (invisible) claim.

There's also the matter of the date -  more than 6 months after the date of service.

Stefanie assured me (You're eligible. YAY!) that Medicare would pay its part and BC/BS would cover the rest.  And those payments would be significantly less than the $350 they were billing me.

I'm a savvy consumer (TBG has spent the afternoon telling me that).  I have the time and the bandwidth (I'm spending too much time with my millennials; their verbiage has invaded my vocabulary) to pursue things like this.  I was lucky to find two women (one working for the federal government, putting the lie to ineffective and lazy civil servants) who were willing to go just a little bit further to help a client.  

Imagine if I were a scared old person with no one to ask, no way to search the internet for phone numbers (local or governmental), reliant on a phone system that still has not returned any of my calls and did not pick up while I let it ring for a lot longer than I wanted to listen to their robo-announcer.  drone on.  Would I have paid the bill and padded the pockets of the bill collector (Athena Health, whose website is all about maximizing efficiency and profitability) and the hospital behind the new owners of that location?  

It could be nothing more than a clerical error.  Given what I know about insurance and health care and billing, I'm more than a little skeptical.