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Jitsen | Insurance says the doctor didn't bill correctly and the doctor says talk to the insurance company. Now what? |
We went to an Ob/Gyn who did an annual exam and now the insurance company won't pay for the visit and says the doctor billed everything wrong. The doctor says take it up with the insurance company. The insurance company says take it up with the doctors office. And we just keep getting bills for $2000 for an annual exam! What do we do? We can't afford that at all. We are just students. Is there someone out there that can help fix this? Is there a service like the Better Business Bureau for medical practices? |
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Melissa
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I've had good luck resolving these painful red-tape incidents by getting both parties on a three-way phone call and hashing it out. Get the doctor's office insurance person on the phone and then call the insurer and mediate it yourself. Write down everyone's name, what they agreed to and the date and keep it in a file until everything is resolved. Good luck!!
Edit: Oh yeah, and as a last resort you can contact your state's insurance commission to complain, if you think it's the insurer at fault. They are the BBB of insurance, but you can also complain to the BBB. |
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Wicked Good
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$2000 for a annual exam? That is outrageous, the doctors office is definately doing something wrong. People pay that for the entire 9 months of pregnancy. Not for one exam. I would send a certified letter in writing to the doctors office telling them the insurance company has requested they rebill the doctors office. With a certified copy you have proof you requested it. If that doesn't get them on the ball then send a copy of the certified letter, the bill and information about the entire problem to the insurance board in your state. |
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Suzanne: YPA
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Your best option at this time is to send a written complaint to your state's insurance commissioner's office. An investigator will look into your concerns by contacting the insurance company.
Insurers cannot change or correct claim information; that's why the insurer cannot help you. Your doctor's office will have no idea what codes the insurer prefers unless it's a participating provider (if the doctor participates with the insurer, he or she is responsible for filing your claim correctly). In order to get both sides to talk to each other, you need an intermediary, which is something your insurance commissioner is used to doing. Best of all, the process is free. |
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Jessica A
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What insurance company do you have? Honestly, they cannot bill you for something because the doctor coded incorrectly. Whenver you're speaking with you insurance company, make sure that you write down the names of everyone that you speak with, first and last or their employee identification numbers, and ask to speak with managers before you even get started. It doesn't seem like it would make a difference, but it does. It make take a little bit of time, but call everyday, and don't let them slide. If youre insurance is through one of your employers, have your employer contact their insurance rep too, and make them aware of the situation. no insurance company wants to lose a business because of something as simple as coding. |
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mbrcatz
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You ask the insurance company for claim forms, fill them out (call the insurance company if you have to, to talk you through it!), bring them to the doctor to sign, then mail them in to the insurance company yourself.
The doctor isn't "responsible" for filing an insurance claim on YOUR policy - YOU are. |
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Angie Milhous
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First of all, if you are getting a bill from the insurance company for an annual exam costing $2000 the doctor is definitely at fault.
The way the insurance industry works is that a doctor submits a bill with codes called ICD-9. Those code are linked to a table that has usual and customary rates for certain procedures/visits. There isn't a code in that table that would allow for a $2000 annual exam.
There are 2 ways to handle this. First, if the doctor is billing incorrect codes he could be charged with fraudulent billing. There are entire departments in insurance companies assigned to monitoring this activity and they are usually called BEAF units (Billing, Errors, Abuse, Fraud). You could call the insurance company, ask for the billing abuse department and explain your case.
The next thing is to call your doctors office and explain that a $2000 bill for an annual exam is probably an error but if they don't want to help you will have no other alternative than to report them to the Office of Inspector General (OIG) for fraud. This is a federal department. Then ask for someone in billing. Some doctors use another company to handle the billing.
Oh, there is one other alternative. Most states have something called a PRO/QRO (Peer Review Organization or Quality Review Organization). You could call the insurance company, ask for the appeals department, ask how to file an appeal, supbmit an appeal and then if they don't overturn the decision, file with the QRO (the insurance company, by law must tell you in the letter how to do that if they don't rule in your favor).
I know this is a lot of information. Let me know if you need more details.
http://www.AngieMilhous.com |
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