Went to the doctor, entire visit added up to about 550.00. He billed my insurance first for cortisone injection at a total of 134.00 and got paid 91.00, month later he billed insurance for same procedure (only went one time to the doctor) at 1434.00 (same cortisone injection) and got paid 961.00. So he got over 1000.00 for a 550.00 visit and now has billed be for an additional 285.00. I don't think I should have to pay this, but need to know who to contact to find out if I am liable for this payment. Any suggestions???
2007-01-17 18:10:08 · 9 answers · asked by Debbie H 3 in Business & Finance ➔ Insurance
keep documentation and report him.
2007-01-17 18:18:02 · answer #1 · answered by mslltaylor 2 · 0⤊ 0⤋
Do not be too quick to report for fraud. I am a medical biller for n group of ER physicians. I sent in a charge for $129, the ins co applied it to the deductible and I filed an appeal on behalf of the pateint. When the insurance carrier got the appeal they entered the charge as $1029 instead of $129. $134 and $1434 are pretty close. Make sure the physician's office didn't just send in an appeal request because they think the insurance company paid the claim incorrectly and then the insurance carrier entered the information into their system.
I would not pay anything until you talk with both the physician's office and find out why they billed the way they did - they may discover their own mistake and make the correction. If you get no where there then go to your insurance carrier.
If you find that it is fraud, by all means, reprot it.
Just remember, MOST physicians are not out to commit fraud and human error does occur. Give the benefit of the doubt BEFORE jumping right into reporting for fraud.
2007-01-18 00:35:42 · answer #2 · answered by sawftandtender 4 · 1⤊ 0⤋
Well, first contact the doctor's billing office. It could be an honest mistake. You have to FIRST CONTEST the billing, and give them a chance to fix it. If you don't contest it, you ARE liable for it.
If the doctor says you were there twice, or doesn't otherwise explain why he is billing one procedure two different times, then call your insurance company, and ask THEM why the same procedure has been billed and paid multiple times.
The way you've outlined it, it DOES sound like either an honest error, or medical billing fraud, in which case you'll need to contact your state insurance department, but the insurance company and the doctor's billing office are the first two calls to make.
2007-01-18 01:17:26 · answer #3 · answered by Anonymous 7 · 1⤊ 0⤋
You are missing several things, for example: 1. You don't pay the insurance company what you owe. You pay the doctor what you owe. 2. The letter from the insurance company is not a bill. It is an explanation of benefits.
2016-05-24 02:34:27 · answer #4 · answered by Anonymous · 0⤊ 0⤋
One doctor I see charges for a visit, then the building sends a bill for the office call. I pay Dr. X-$50 & the office building charges $20. Something new to me!
Your case sounds different, the insurance company will like to hear from you on that.
2007-01-17 18:22:29 · answer #5 · answered by S. B. 6 · 0⤊ 0⤋
Contact your insurance company and make them aware of the situation and ask them where you need to go from there. Insurance companies want to pay as little as possible and if this Dr. is trying to commit fraud, you'll have no problem getting help from your insurance.
2007-01-17 18:15:29 · answer #6 · answered by Anonymous · 2⤊ 0⤋
To add to what saw & mb said - it's also possible that there's another patient with your same name that was seen the 2nd time and it went to your insurance by mistake.
Like they said - human error does occur, so start by having the doctor's office research it on their end first.
2007-01-18 02:55:48 · answer #7 · answered by zippythejessi 7 · 0⤊ 0⤋
talk to the insurance company
2007-01-17 18:14:18 · answer #8 · answered by trawet 3 · 0⤊ 0⤋
no
2007-01-17 18:25:12 · answer #9 · answered by Stail 1 · 0⤊ 0⤋