posted
About a year back, I got a medical bill of a few hundred dollars for a medical service that happened a couple of years before. The insurance company decided they overpaid, asked for the money back, and the doctor was then asking me for that money.
This was for a proceedure I was told by my insurance at the forefront would be covered %100. I was not "supposed" to owe anything for it.
I would talk to the doctor, and they told me I was responsible for anything the insurance didn't pay. I would talk to the insurance, and they would say that the networked provider had signed a contract and agreed to a certain amount of money and it was unlawful for them to go after me for more than that. The doctors were about to send creditors after me.
I finally got them talking to each other, and never heard any more about it. So, that means that in the negotiations, I don't know which party "gave in" or if there was a compromise.
Well, it is happening again, but with a smaller amount of money. It was a regular checkup last year, we paid our normal copay, and the doctor is billing us for what the insurance didn't pay.
Quite often in these cases I just wait and it is eventually paid by the insurance. Well, I've waited long enough that they are being "threatening" again. Both sides are telling me the exact same thing as last time. The doctor says patient is responsible for whatever insurance doesn't pay. They don't care what your coverage says. Insurance says they have a legal contract with the network provider that agrees on a specific amount, and the provider is bound by the contract to not "go after" the patient for any more money.
I can pay this, it isn't an exorbitant amount of money. But it is the principle of the thing that bothers me. To get two such different stories from the different sides. I don't know if I'm being taken advantage of or if I am just being stingy and stubborn.
I'm sure many of you out there have had to deal with similar things. I would love some input on this situation.
posted
I agree - you put up with a lot to stay within network. You're owed that advantage.
If the doctor is the one violating his contract, then he is cheating. If it's the insurance company not paying what they should, then they are cheating.
It's legitimate to give in due to time or effort involved, assuming you factor in likely future behavior giving in will cause, but you shouldn't feel guilty for standing up for your rights.
Posts: 26071 | Registered: Oct 2003
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posted
I will try. But I worry I am "running out of time". My insurance refuses to make an outbound call to the doctor, and the account person at the doctor is on vacation. Grrrr.
Posts: 7050 | Registered: Feb 2004
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posted
I am afraid of creditors, especially since it was threatened last time. It seems like creditors are big bullies with too much power to ruin your life.
Posts: 7050 | Registered: Feb 2004
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posted
You're definitely being taken advantage of, and not being stingy. Unfortunately I don't know much about what creditors are and aren't allowed to do in such situations:(
Posts: 17164 | Registered: Jun 2001
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posted
In my insurance world, the doctor is not supposed to do this. If the insurance can't make the outbound call, can you call one of them and then add the other on? Or, if you don't have three-way calling, call the insurance company and ask them to add the doctor's office on? They may be able to make an outgoing call if you're on the line with them.
(The reason for this is if it is an inbound call center the reps are evaluated on how much time they are open for calls. If they call out, all that time counts against them. But if they accept your inbound call, and then place an outbound call with you still on the line, it's still being counted as part of your inbound call so it doesn't hurt their numbers.)
Anyway, I've frequently found that getting both parties on the phone with you listening in is the best way to get things accomplished.
Posts: 7954 | Registered: Mar 2004
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quote: the doctor is billing us for what the insurance didn't pay.
That's the part that makes me think that (at least this time) it is the doctor's office that is at fault here. There should be an automatic write-off of some amount, and it sounds like that isn't happening.
Do you have a friend who is a lawyer who will (for a small fee) write a nasty letter to the doctor's billing office reminding them of this?
Posts: 32919 | Registered: Mar 2003
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posted
ElJay: The insurance lady offered to be on a three-way call, but my only phone is a cell that isn't capable of that. I really wish I could do that--it would be quite an education, I would think, to hear the two sides talking it out! For instance, I really wish I knew what happened last time.
Rivka, the insurance company always offers to send a letter telling the doctors to cut it out. They did it last time too, but the doctors office didn't pay any attention. In this case, even if the letter would help, it won't reach them for at least a week, maybe two.
My most recent action was to leave a message for the account people to call my insurance and try to work something out. I just fear that they won't because deep down they know they won't get another penny out of the insurance company and they believe they *can* get the money out of me.
If this continues to be trouble and I finally get to talk to the account people at the doctors office, I am toying with the idea of talking tough and threatening to get a lawyer in on it. I don't know if that really works, though. There are a few lawyers in my neighborhood, though I'm not terribly close to them.
Posts: 7050 | Registered: Feb 2004
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posted
bev, but she might be able to initiate the 3 way call, then it doesn't matter that your phone can't. If she offered, she probably can do it. For you it's just the same as if she put you on hold and then came back. . . you might have to give her the number to your doctor's office, but that's it.
Posts: 7954 | Registered: Mar 2004
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posted
She offered to be in a 3-way only if I could make the call. It sounded like it was something she couldn't do herself.
Posts: 7050 | Registered: Feb 2004
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posted
Well, the account person wasn't in anyway. Perhaps when I know she *is* in, I will go to my in-laws and make a 3-way call. Posts: 7050 | Registered: Feb 2004
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posted
Thank you for posting this today, Bev. I have an issue with my insurance company I need to work through as well, and I had put it aside and totally forgotten about it until I read this thread. Now I'm on the phone with them! *grin*
posted
I am having similar, but much more severe problems with my insurance company and health-care provider.
YOU MUST GET EVERYTHING IN WRITING. YOU MUST TAKE COPIOUS NOTES DURING EVERY CONVERSATION.
If your insurance company sends a "cease and desist" type of letter to your doctor, have them send you a copy. If your doctor pursues it, bring it to your state's Atty General office, and also present the letter to the collection agancy.
And get a new doctor.
Fight it. Do not back off. You are completely in the right.
posted
Thanks for the good, solid avice, Steve. I didn't think to ask my insurance company to mail me a copy of the letter. I need to call them for something different today anyway. I will request they do that.
Posts: 7050 | Registered: Feb 2004
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posted
The problems I've had like this have been either because the doctor's office didn't have the correct address for the insurance company or because I switched doctors and neglected to notify the insurance company (my fault, but once the switch was officially made, everything was fine).
Good luck. I know it's a big pain. I hope things work out right for you.
Posts: 1090 | Registered: Oct 2003
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posted
Okay, Bev - first, if they do turn you over to a collection agency, you still have rights here. I went through this with a bill from Children's Hospital for occupational therapy for my son once. They tried to bill me for the whole thing, I told them that insurance was supposed to cover, and they gave me a run-around.
Turns out they never even filed the claim. But anyway, what I'm saying is Children's turned it over to a collection agency. They have to notify you in writing of the attempt to collect. At that moment, fire off a letter to the collection agency telling them the debt is in dispute, that you are denying that you owe anything and that they should contact your insurance agency.
Once they get that letter from you they CANNOT do anything to your credit report until the dispute is resolved.
Nine times out of ten, when you dispute it, and the collection company calls the doctor's office to say it's unders dispute the doctor's office will write it off. But be sure to keep every letter you get. And write down the name and title of everyone you speak to as well as the date and time of every call.
In my case the hospital was at fault, and once I stood up and refused to give in to the collection agency's threats the hospital decided they better talk to my insurance company and lo and behold, it was paid for. Good luck.
Posts: 14428 | Registered: Aug 2001
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posted
Belle, thanks!! That is awesome advice. I asked that the insurance company send a copy of that letter to me. I will use it to protect myself if I need to. I need to record that I left a message with the doctor's account person yesterday.
Situations like this just make me think that there are a lot of stupid/dishonest people out there.
Posts: 7050 | Registered: Feb 2004
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posted
My insurance company and doctor's office were much nicer to me today than what bev is experiencing. I had a procedure done in May and the EOB said it was denied payment because I didn't have my preferred provider's referral to this specialist. But I knew that I DID have a referral, so I called the doc office and the lady there was super sweet, and is taking care of everything.
It doesn't help that my preferred provider changed (my doctor moved out of area) right at the time this is all happening, so it is kind of a mixed up deal. But they handled it beautifully.
posted
Okay, here is information EVERYONE needs to know. It's an FAQ on the Fair Debt Collections Practice Act. I'm also including a link to the actual Act itself from a government website, but it's hard to make sense of unless you're Dag and can read all that legalese.
quote:When consumers have not notified the collection agency in writing that the debt is disputed, Section 809(b) permits collectors to continue collection activity including demands for payment and taking legal action.
The FDCPA treats the thirty-days as a dispute period within which the consumer (debtor) may insist that the collector verify the debt and not a grace period that prohibits collection efforts.
However, the collection agency must ensure its collection activity does not overshadow and is not inconsistent with the disclosure of a consumer's right to dispute the debt as specified in Section 809(a).
Finally, once you dispute a debt in writing, ALL collection actions must cease until the collector validates the debt in accordance with Section 809.
I can tell you, it was invaluable to me to use this against the collection company. They called after I had already mailed my letter and I just told them "I'm disputing this debt in writing, you should receive the letter soon. Please don't call again." Never heard from them again. Instead, Children's Hospital called me to say they were filing with my insurance company and they were "sorry for the mixup."
Posts: 14428 | Registered: Aug 2001
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posted
I have a somewhat similar situation with one of our doctors. The contract rates are significantly lower than their usual and customary. When I first verified benefits, etc. before our first visit, the insurance rep told me that she couldn't disclose that contract rate to me, that I should pay my copay and the 50% coinsurance (this is psych, the coins is horrid) based on their U/C, and then once the insurance company started paying based on contract, I could determine how much the overpay was and we'd get it straightened out.
Didn't like the sound of that but I wasn't going to get any better information anywhere, so off we go. The doctor's U/C isn't so exorbitant that paying the 50% off that was breaking the bank, but when I found out from my COB statements that the contract rate was roughly that same 50%, naturally I called to get a credit applied for what I'd already been paying.
The billing manager was very pleasant and credited my account with no problems. What she didn't do, however, was to mark the file with the correct contract rates so that the Saturday receptionist who didn't have a clue what was happening could charge me the right amount. So every month for the next 6 or so, I'd have to verbally battle with the poor girl over how much I was supposed to pay. I don't remember why the billing manager was unavailable during regular hours for all that time, but I finally got to the point where I said that I wasn't going to pay anything more until Linda contacted me because I once again had accumulated a significant credit. Gee, that worked fast! Linda called me the very next Monday, credited the account again, and this time put a big note in the file on neon paper with the correct amounts.
Sometimes you just have to be a squeaky wheel. And if you aren't able to squeak loudly enough to get satisfaction, then maybe it's time to seek out a new doctor's office. I hope it doesn't come to that for you, though, I know how much of a pain it is to find a new provider that you like and that's covered by your plan.
Posts: 4515 | Registered: Jul 2004
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quote:Aren't doctors supposed to do no harm and help people? ------------------------------------------------------------------------
yeah, that's why they hire laypeople to do all this stuff. It's not your doctor, it's your doctor's billing department. The doctors follow very strict rules on not "getting their hands messy" with the billing.
Also, by being part of the insurance network, the doctor should be agreeing not to bill more than what the insurance has told them they will be paid. So you can "threaten" the doctor's office that you will petition the insurance company to have them removed from the network.
Also- all the stuff about putting everything in writing and sending copies of what you send the insurance and what they send you and likewise with the doctor is better than a three way call. It should also give them the fear that you might be a obsessive borderline stalker type.
Posts: 2010 | Registered: Apr 2003
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posted
This isn't exactly the same situation, but at one time, for a period of about a year, I kept receiving a bill for medical services from a facility whose name I didn't recognize, sent to me through a collection service. The bill contained no contact information for the medical facility, so I ignored it. Finally, I received a threatening letter from a lawyer. I wrote back to the lawyer stating that I had no idea what the charge was for, and asking them to please let me know what service was provided and who the providing doctor was. I never heard from them again, and nothing went on my credit record.
Posts: 5771 | Registered: Nov 2000
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posted
I once got a call from a collection agency (or someone claiming to be one) about a bill from my doctor's office. I didn't think I had any outstanding bills with them, so I asked for details. They had no date of service, no information about what the service was, but claimed it was "severely passed due" and they wanted me to "arrange payment" by credit card or authorized withdrawl from my checking account over the phone. When I told the guy I wasn't going to pay anything without a date that the supposed service took place, he asked for my social security number to "verify the records." Yeah, right. I Told him I'd check directly with the clinic and hung up. Never heard from him again.
Posts: 9866 | Registered: Apr 2002
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Even after you've assumed the deal to be over and done with, you have to get THAT in writing, too!
Over THREE YEARS AGO, my insurance company was convinced that I owed them over $1000 (I had to go to a physical therapist, so the P/T called the insurer, were told they were in-network, and I started going with a $5 co-pay. Six weeks in, we were told, "No, you're not in network, and now that you've been getting treatments without "prior approval," we're only covering 50% "reasonable & customary" and things went downhill from there.)
After asking them repeatedly for paperwork to prove their claim against me (which they could never do), they stopped harassing me. I, too, thought it was all over and done with.
It wasn't.
Beginning of this year, they decided that instead of reimbursing me for out-of-network coverage (80%), they would keep the money themselves, and use it against my as-of-yet unconfirmed "debt".
I'm still fighting it.
(Got to go; perhaps more later)
Posts: 1862 | Registered: Mar 2000
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Called my insurance company this morning. After months and years of fighting it, they have said "You may actually be getting some money back, after all.* But we can't be sure until all the analysis works itself through the system, and the checks are (or aren't) printed Wednesday morning. Meanwhile, it's not an 'official' statement."
So, at least a conditional w00t for me.
* I thought this might happen, when they looked at the 50% vs. 80% recovery rate. I offered, early on, to call it "even," and to save them "man"-weeks of recent work to figure this all out. But would they listen---oh, no!
Posts: 1862 | Registered: Mar 2000
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posted
bev, I asked my wife about this last night. She used to work in health insurance. As I thought, in Florida at least, it is illegal for the doctor to balance bill you if he has a contract with the insurance company. You might want to check with the Dept. of Insurance in your state and ask them. If so, the next time the doctor's office harrasses you, let them know that you're going to report them to the state.
Posts: 4625 | Registered: Jul 2002
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posted
Except that as mothertree pointed out, it's not the doctor who's handling the billing stuff, it's the laypeople that the clinic is hiring. Unfortunately, since the one comes hand-in-hand with the other, seems that the only options are to get the morons educated and/or relieved of duty, or to change clinics.
quote:let them know that you're going to report them to the state.
Yay! More ammunition! Thanks so much, everyone. Not only do I feel more confident about my rights and how things actually work, I feel like I have some real information to protect me.
Posts: 7050 | Registered: Feb 2004
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posted
Well, I just got a call from the accounts person. She looked at the situation, and told me frankly that someone forgot to put the remainder as a "write-off"! She told me to disregard the bill and that was that.
Whew! I didn't even have to wrestle with anyone over this. Thank you all so much. I imagine this will happen in the future as well, and when it does, I will know better what to do. Posts: 7050 | Registered: Feb 2004
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posted
Uppdate: just got word that instead of me "owing" my insurance company over $1000, they owe me over $2000! Apparently, they cut me a check and mailed it out this Tuesday (8/4/05).
And I'm getting it all in writing, including the closure with the collection agency they had called in almost two months ago.
PERSEVERANCE PAYS!
I'm now over $3000 ahead of where I was...um...before Tuesday!
posted
My wife said that doctor's office routinely balance bill their patients. They do it knowing they'll have to write it off if someone calls them on it, but there are many people who just pay it.
Posts: 4625 | Registered: Jul 2002
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posted
zgator, that is why I rarely pay a medical bill I've just received. Whether or not they've heard back from insurance, they just go ahead and bill automatically. In fact, I just got a bill today for over $600 for a routine checkup on my two girls. What do I do? I ignore it and wait.
Whether or not they are doing it purposely in hopes of someone paying and getting paid twice, I have wondered that myself. They may indeed be doing it dishonestly on purpose. If so, isn't that insurance fraud? Anytime someone gets paid twice or overpaid?
ssywak, I didn't get it in writing. Hopefully I will not regret that. But I'm not too concerned in this particular case.
Posts: 7050 | Registered: Feb 2004
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I really wish I could do that--it would be quite an education, I would think, to hear the two sides talking it out! For instance, I really wish I knew what happened last time.![[Big Grin]](biggrin.gif)
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