Insurance says the doctor didn't bill correctly and the doctor says talk to the insurance company. Now what?

Question

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?

Answer 1

Get out your insurance manual and find in the book what their billing procedure is. Call your insurance rep and point this procedure out to them. Tell them that unless they explain to the billing dept. of your doctors office how they would like it billed, they aren't going to get paid. After all, you aren't the one at fault. Sounds to me like nobody wants to be bothered with the red tape of fixing an error.

Answer 2

#1 Appeal the claim thru your health insurance co. You must do this to avoid being responsible for the billing, as there is a time cut-off with filing it. The appeal process will either be on the back of the explanation of benefits statement you rec'd or call their 800 number to ask about the process, but appeals need to be in writing. Then actually talk to Dr.'s office actual insurance person, also talkt o a supervisor at insurance customer service. See if that person would take a call from the Dr.'s insurance person and get them to talk to each other to straighten out claim.

Answer 3

I did billing for years so I can help you WIth this. Call your OB/Gym and talk to the nurse. Tell her exactly what procedures you had done when the doctor was with you. Then ask her to tell you the CPT codes for those procedures. Write these codes down, then ask her for the person who handles the doctor's billing. Talk with the biller, and ask her to tell you what CPT codes she billed the insurance company with. If you see a discrepancy with what she billed with what the codes were the nurse gave you, then let her know there was a billing error and ask her to correct and resubmit. This is presuming you have an indemnity insurance plan or a PPO. If you have a HMO, then if you paid your copay, they can't bill you for another dime-it's illegal. I hope this makes sense, if not-please email me through the answer email service and I'll help you further. It definitely sounds like the billing department made the error. Good luck!

Answer 4

your basically right selection at present is to deliver a written criticism on your state's insurance commissioner's workplace. An investigator will inspect your concerns by utilising contacting the insurance business business enterprise. Insurers can not exchange or the basically right option declare counsel; it quite is why the insurer can not help you. Your wellbeing care expert's workplace will have not have been given any thought what codes the insurer prefers except that's a partaking provider (if the wellbeing care expert participates with the insurer, he or she is to blame for submitting your declare wisely). as a fashion to get the two aspects to talk to a minimum of one yet another, you opt for an middleman, it quite is something your insurance commissioner is used to doing. basically right of all, the approach is unfastened.

Answer 5

u need to go to the dr's office with ur bill from them and the rejection from ur ins company. the ins co rejected the bill i bet because the wrong codes were used. if all u got was a annual exam first make sure it is covered by ur ins co, if it is then go to the dr. office and see who does the billing/coding there. u need to talk to them so they can investigate the problem to make sure all the correct codes were used for billing the procedure done. really ur ins co is supposed to be doing all this work for u "patient first rule", therefore i would ask to speak to the manager of ur ins billing dept and tell them what is going on. the ins co is supposed to look over the claim to make sure the codes are correct for the procedures done and if not get documentation to correct the problem if the bill is coded incorrectly by the drs office.

Answer 6

You have to find out your legal rights, so a lawyer and court related materials could help you find and read their obligations(contracts) and correct procedures they have to follow legally. Nobody will charge you for guiding you in the right direction. The government offers services to get you in the right directions but you have to inquirer about them. Bring a recorder don't hide it and record when you have the permission.Nobody can guess whats in the contracts and legal obligations of both parties so it could get complicated.Talk to sources like an insurance lawyer.
http://www.law.cornell.edu/wex/index.php/Insurance
http://www.ilawyer.com/library/FAQ_insurance.jsp
http://www.findlaw.com/01topics/44insurance/sites.html
http://www.irmi.com/Expert/Topics/InsuranceLaw/Case%20Of%20The%20Month.aspx

Answer 7

Sue.