3 On Your Side

UPDATE: Insurance carrier decides not to pay medical bill

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Aaron Rodriguez sure is frustrated. He thought a billing mistake he had nearly a year ago had been resolved and so did 3 On Your Side.

"OK, I'm back to square one now," a frustrated Rodriguez told 3 On Your Side. "There was a sense of relief. I had confidence it was going to be handled and it just hasn't."

3 On Your Side told you about Rodriguez and his medical bill fiasco last year. At that time, he was getting a bill for more than $1,000 from his doctor's office, which is part of Dignity Health. The bill stemmed from his annual preventative physical, which is covered at 100 percent by his insurance company, Blue Cross Blue Shield.

But during his exam Rodriguez says his doctor found some things that were concerning so he ordered some tests. 

"As a precaution, in his words, we would like to run these tests," Rodriguez said.

But those tests left Rodriguez with that $1,000 bill. After 3 On Your Side got involved, it was discovered that a coding problem needed to be corrected and the issue would be resolved.

"The big issue was the coding of the bill," Rodriguez said. "It was coded as a diagnostic code as opposed to a preventative code."

At that time, Rodriguez's doctor's office at Dignity Health agreed to re-code the tests as "preventative" and resubmitted it to Blue Cross Blue Shield. The matter appeared to have been resolved. However, nine months later, Rodriguez is getting billed again because Blue Cross Blue Shield just won't pay.

"I've called the insurance company and they say they can't do anything until they receive an updated bill," Rodriguez said. "Their hands are tied on that."

Well, 3 On Your Side learned that Dignity Health did in fact send Blue Cross Blue Shield the re-coded bill as promised, but the insurance company still didn't want to pay then and doesn't want to pay now.

In fact, Blue Cross Blue Shield tells us that even though the bill was re-coded as preventive, the company disagrees and considers the X-ray or CT scan that Rodriguez had done as outside preventive. As a result, they say Rodriguez is stuck with paying the $1,000 bill.

Rodriguez says he can't believe it.

"I feel helpless, frustrated and kind of undermined," he said.

Rodriguez said he has lost faith in the health insurance industry. He simply wanted a routine physical that was supposed to be covered 100 percent with nothing out of pocket, and now he's stuck paying $1,000.

[RELATED: Annual physical uncovers big problem ... with medical bill]

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