I’m trying to understand whether I have any options here or if I’m stuck with a ~$5,200 medical bill.
In 2025, I was receiving ongoing treatment at a reproductive endocrinology clinic. At the time, I had two insurance plans:
- Blue Care Network (BCN) through my employer (primary)
- HAP through my spouse (secondary)
Here’s the timeline of what happened:
- August 2025: I informed the clinic that I had both BCN and HAP coverage after starting a new job.
- I was told they “don’t take BCN” but nothing further was explained (no guidance about billing, coordination, etc.).
- I was already an established patient and continued care.
- September 1, 2025: I was told by the clinic that they dropped HAP (Back in June and they never told me) that I could continue as an in-network patient under HAP as long as care was continuous and there were no breaks in treatment. Based on that, I continued appointments.
- September 1–29, 2025: I received services under the assumption I was still in-network.
- September 29, 2025: I was billed ~$2,607, which I was not expecting. Later, I was told the clinic was actually out-of-network with HAP during this time and I had not been notified of that change. They acknowledged they messed up and told me they would submit this bill, continue to bill HAP in network, and that they would continue to bill HAP as in network for my last few treatment cycles.
- After that, claims were initially paid by HAP, then later fully recouped because Blue Cross (BCN) was determined to be primary under coordination of benefits (COB).
- April 2026: I now received a revised balance of about $5,200, with the clinic saying:
- HAP denied due to COB (BCN primary)
- BCN is out-of-network and won’t pay
- It’s my responsibility to resolve COB with both insurers
The clinic is now saying I must:
- fix COB between insurers
- and that they cannot bill BCN (out-of-network)
My concern is:
- I disclosed both insurances when coverage changed
- I was never told BCN should be primary or that this would affect billing this way
- I was never clearly informed the clinic was no longer in-network with HAP before receiving care
- I continued treatment under the belief I was in-network
Now I’m stuck with a large bill that seems to come from a combination of insurance coordination issues + lack of notice from the provider.
My questions:
- Do I have any leverage to dispute this with the clinic or insurers?
- Is this something that can be corrected through COB appeals or late claims submission?
- Or am I likely responsible because BCN is primary even though it was never billed properly?
- Would this be worth escalating to a state insurance regulator in Michigan?
Any advice on next steps would be really appreciated.
u/Beneficial-Medium298 — 16 days ago