How do I tell if my doctor is scamming me and my insurance company?

Question

My son's pediatrician is always telling me about new balances that I have accrued there because of what insurance won't pay. So every time we're there I end up paying off the "balance" (which is never less than $100) in addition to my co-pay. We have also have a chiropractor, a dentist, our regular GP and my OB-GYN doctor. I have never had anything like this with the other doctors. I may have a small balance but nothing like what his pediatrician is charging. So I think the woman who does the billing either doesn't know what she is doing or she's playing dumb and scamming me. How can I tell? Have any other parents had anything like this come up?

And the insurance is a PPO- Blue Cross Blue Shield. It's the best coverage you can have. So it's not like I have a cheap plan.

Yes, Judy, I do receive statements but they don't correspond with his visits. For instance I may go 3 times in 6 months but only get one statement showing charges for one visit. It doesn't add up.
Thank you for answering my question...

And yes, he's an in-network doctor.

Answer 1

I don't have that particular insurance, but here is what I would do in this situation. First, I would check to make sure that doctor is part of the BCBS network. If you go to a non-network doctor, you will end up paying more out of your pocket.
Secondly, I would check with your insurance company and find out what your out-of-pocket expense should be for each doctor's visit. If there is a difference, then you need to follow up.

Answer 2

I can't say I know about too much of this and I hope someone else does but about the only thing I can advise is to talk to your insurance provider and ask about these balances and most importantly educate yourself about the processes and perhaps you'll find out why this is happening if in fact it is legal and legit. Sorry I can't be of more help I but I wish for the best for you and your family.

Answer 3

If he's a network doctor, his charges should match the information on the insurance Explanation of Benefits. If they don't, it should be questioned.

Answer 4

Don't you get some sort of statement from your insurance showing for each service provided what the doctor billed, what the insurance paid, and what you are responsible for?