Provider's billing service can't get it right--advice? (plan, hospital, MRI)

[BSJSAS]

I'm hoping someone has some thoughts about what I can do in this situation. I feel as if I've tried everything and am tired of being billed for services that should be mostly paid by insurance.

I had some kind of episode that worried my DH, so he took me to Urgent Care who sent me to the hospital. I was in the ED for about 15 hours overnight, but was never admitted as far as I know. Many lab and diagnostic tests were done.

Almost all of the EOB's were processed, and everything paid by me or insurance except for the Radiologist practice (for reading the xrays, CT, MRI etc.) Their billing is handled by some outsourced billing service. All the other charges (hospital, meds, the diagnostic tests, lab, hospitalists, other specialists etc.) have billed and been paid.

The radiologist claims keep being denied for one of 2 reasons (it flip flops each time they submit): Lack of authorization or insured cannot be identified. The lack of authorization denial is because they insist on billing as inpatient. The carrier cannot identify me because they will not put my member code (01-I'm primary) on the claim and/or they insist on submitting to the plan in the state where services were rendered whereas I have a policy with a national company through a previous employer in a different state and claims are supposed to go directly to them.

I have called the billing company at least 7 times, and even had a carrier representative conferenced in on one of the calls so she could explain to them how to properly submit their claims. Each time, they say they will put it in pending, review it and resubmit correctly, but each time they don't-- and get denied again.

I tried to call the actual provider, but as is the case where I live they often do not answer calls in the office and only give you an option to press 1 for billing. That, of course, just connects you to the service that can't seem to get it right. So, I tried a random option in their phone tree and left a detailed message. Also, submitted a comment on their website comment form (from which you have to select the issue--billing--and it probably gets forwarded directly to that billing service!)

I know I don't owe the entire amount. If the billing people are that incompetent, what can I do. And, if they truly are being denied for lack of authorization, is that my fault?

My next step might be to drive to the radiologist office and insist on speaking to someone. It's all I can think of at this point. I am sure that if I need radiology services in the future, I'll try to be sure the films aren't sent to them if I can get a choice in that.

Sorry this is so long. Any suggestions?