- Mem,
What they probably did is look up the code alphabetically (to get the number) and entered the wrong one. That would be my story, anyway. :biggrin1:
HELP! Dr. Office misbilled and they wont fix
- Thread starter Rikter8
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What they probably did is look up the code alphabetically (to get the number) and entered the wrong one. That would be my story, anyway. :biggrin1:
well don't say i didn't try to help.
**tosses matches and bucket of gasoline to the ground and stomps away**
D_Chaumbrelayne_Copprehead
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Get some notes or a letter from the insurance company and the lab. Document your case, don't threaten anything yet, but go to the doctor's office and don't take NO for an answer.
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Report it to the State Insurance Commisioner...I have done that and gotten the mistake corrected.
molotovmuffin
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Get in touch with your state's Office of the Attorney General. That should get their attention.
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Actually she looked a bit disgusted. Her and the panel of 5 ladies sitting in their welcome counter/call center seats next to the restroom where I did the deed.
I heard her wisper - "he's in the stall" then clam up as I walked by.. All eyes on me.
I was waiting for them to hold up score signs.
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Andrew Shirvell and Mike Cox?
I will try... they are busy playing anti-gay superhero's right now.
molotovmuffin
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As the person on the other side of the counter, I have 2 issues with what you've said here, submissivegirl83.
It is NOT the office's responsibility to know what a patient's insurance company will cover. Even with a major company, like the Blues or Humana, EVERY policy is different, depending on the options selected by the employer. It would be impossible for the office to know what would or wouldn't be covered for even half of the policies. Most likely, at the first visit of the year, the patient has signed a release/consent that said something about billing the insurance being a courtesy and it being the patient's responsibility to know what is covered and what isn't.
Also, ABNs apply only to Medicare patients.
On the other hand, Rikter8, I'm very sorry that you've had such a difficult time getting this problem resolved. Most likely, the office is affiliated with a hospital or other larger organization. If so, contact the Patient Advocate at the hospital. Call the switchboard at the hospital and asked to be transferred to that person, or call your doctor's office and ask for the number (without telling them who you are or why you want the number). Explain to the Advocate what's been going on and that you haven't gotten any satisfaction (except in the bathroom that one time) yet. And, as always, remain calm. While the squeaky wheel may get the grease, it also gets a reputation. Trust me, we (the schedulers) will bend over backward for the patients who are pleasant with us and we'll fight over who has to deal with you if you're an ass.
Good luck!
At this point my approach would be the following
1.) Start keeping a journal and document all conversations and correspondence you have with your doctor's office.
2.) Write a letter
Detail what you were seen for and why test was done with all relevant dates etc.
Explain the mistake
Explain how the mistake has caused you to be billed by insurance company when technically you are not responsible.
Tell how you have called and come in numerous times and been told that it would be fixed and it has not been.
Name names if you can.
Mention the phone call where you asked to speak to the doctor because the staff had not fixed the problem and were told you would be charged for an office visit. Tell them you think it is illegal for them to bill you for medical service when none is provided and you were attempting for them to make a correction to your medical records.
Tell them you just wish the matter corrected.
However, if it is not corrected within 5 business days you will be consulting an attorney.
3.) Before sending it
1.) Call your insurance company and find out who you should send a copy of the letter to.
2,) Contact the lab and find out who is handling the accounts so you can send a copy of the letter
3.) Contact the collection agency - same thing
4.) Contact the State Medical Board - Find out who handles complaints
4.) Now Send the letter
Certified
Requiring the Doctor Sign for it (Not his staff!) - That way you make sure he sees it.
cc everyone on the list
do not say I'm going to contact the Medical Board and complain - the doctor will get the message loud and clear.
With the cover letter to the State Medical Board ask if there are other complaints and complaints regarding billing problems.
Specifically ask them if it is illegal to charge someone for a medical office visit to discuss a medical record error and billing problem.
5.) Wait 5 days
6.) Then call the attorney.
Sometimes just a letter or phone call from an attorney does the trick but try to save yourself some $ because before you know it the attorney fees will exceed the amount you saved on the lab bill.
Many attorney's offer initial consultation free.
You may just wish to sue him in small claims court for amount cost because of incorrect billing, plus court costs. Sometimes double or triple damages are allowed - Example if the Lab test cost $1,000 and the insurance does a 50/50 instead of 80/20 then you are billed $500 instead of $200 and you would sue for the difference of $300.
So with triple damages you could go for $900.
Usually there needs to be some kind of fraud involved but the people who handle the filings at the small claims court are usually very helpful and knowledgeable.
ps you may need to get a new doctor if you get an attorney involved or sue.
You may want one anyway.
Good Luck
1.) Start keeping a journal and document all conversations and correspondence you have with your doctor's office.
2.) Write a letter
Detail what you were seen for and why test was done with all relevant dates etc.
Explain the mistake
Explain how the mistake has caused you to be billed by insurance company when technically you are not responsible.
Tell how you have called and come in numerous times and been told that it would be fixed and it has not been.
Name names if you can.
Mention the phone call where you asked to speak to the doctor because the staff had not fixed the problem and were told you would be charged for an office visit. Tell them you think it is illegal for them to bill you for medical service when none is provided and you were attempting for them to make a correction to your medical records.
Tell them you just wish the matter corrected.
However, if it is not corrected within 5 business days you will be consulting an attorney.
3.) Before sending it
1.) Call your insurance company and find out who you should send a copy of the letter to.
2,) Contact the lab and find out who is handling the accounts so you can send a copy of the letter
3.) Contact the collection agency - same thing
4.) Contact the State Medical Board - Find out who handles complaints
4.) Now Send the letter
Certified
Requiring the Doctor Sign for it (Not his staff!) - That way you make sure he sees it.
cc everyone on the list
do not say I'm going to contact the Medical Board and complain - the doctor will get the message loud and clear.
With the cover letter to the State Medical Board ask if there are other complaints and complaints regarding billing problems.
Specifically ask them if it is illegal to charge someone for a medical office visit to discuss a medical record error and billing problem.
5.) Wait 5 days
6.) Then call the attorney.
Sometimes just a letter or phone call from an attorney does the trick but try to save yourself some $ because before you know it the attorney fees will exceed the amount you saved on the lab bill.
Many attorney's offer initial consultation free.
You may just wish to sue him in small claims court for amount cost because of incorrect billing, plus court costs. Sometimes double or triple damages are allowed - Example if the Lab test cost $1,000 and the insurance does a 50/50 instead of 80/20 then you are billed $500 instead of $200 and you would sue for the difference of $300.
So with triple damages you could go for $900.
Usually there needs to be some kind of fraud involved but the people who handle the filings at the small claims court are usually very helpful and knowledgeable.
ps you may need to get a new doctor if you get an attorney involved or sue.
You may want one anyway.
Good Luck
if your insurance is employer-provided, check with the benefits representative. employers can usually get things fixed because it:
> designated the terms, conditions, and coverages for what the carrier provides.
> pays for the policy.
as a former compensation and benefits manager, I assure you the carrier took my calls. also, a time or two I called the provider's (the doctor) office and interceded on behalf of the employee. (I also had an occasional provider call me about an uncooperative employee... the system works both ways.)
the State of California has a department of insurance and the head of it is an ELECTED constitutional officer who wants to please the voters. does your state have such an office?
good luck.
> designated the terms, conditions, and coverages for what the carrier provides.
> pays for the policy.
as a former compensation and benefits manager, I assure you the carrier took my calls. also, a time or two I called the provider's (the doctor) office and interceded on behalf of the employee. (I also had an occasional provider call me about an uncooperative employee... the system works both ways.)
the State of California has a department of insurance and the head of it is an ELECTED constitutional officer who wants to please the voters. does your state have such an office?
good luck.
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Excellent advice. I called a few legal rep's and they had indicated I wait a few weeks since the Doctors office claims they sent in the correct billing information.
That was a couple weeks ago when I went on a tyrant.
I'm going to call my insurance carrier on Monday to see if it had been processed or if there were further issues with it.
If not resolved, I'm going to write the letter like you folks had advised. It's the right thing to do to make it known who's dropping the ball.
I called the doctors office last week and asked for a copy of my records.
They said I have to sign a release (which is normal) but I have to wait for 2 weeks for the records since "They have an outside source process the records for them".
I was like WTF?? 2 weeks for my records??? Why can't they just pull my charts that they've got walls of 6 feet behind them???
Nothing but trouble with this office.
That was a couple weeks ago when I went on a tyrant.
I'm going to call my insurance carrier on Monday to see if it had been processed or if there were further issues with it.
If not resolved, I'm going to write the letter like you folks had advised. It's the right thing to do to make it known who's dropping the ball.
I called the doctors office last week and asked for a copy of my records.
They said I have to sign a release (which is normal) but I have to wait for 2 weeks for the records since "They have an outside source process the records for them".
I was like WTF?? 2 weeks for my records??? Why can't they just pull my charts that they've got walls of 6 feet behind them???
Nothing but trouble with this office.
"Went on a tyrant"
Does that mean you had gay sex with the Prime Minister of Iran and he was the bottom?
Maybe you went on a tirade.
Sounds like you need to make all requests with certified mail.
Maybe when you ask that the problem be corrected in 5 business days you tell them they need to send you a copy of what they sent to the insurance company as proof. (Reference the person in the insurance company whose name is cc at end of your letter)
Does that mean you had gay sex with the Prime Minister of Iran and he was the bottom?
Maybe you went on a tirade.
Sounds like you need to make all requests with certified mail.
Maybe when you ask that the problem be corrected in 5 business days you tell them they need to send you a copy of what they sent to the insurance company as proof. (Reference the person in the insurance company whose name is cc at end of your letter)
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