Question
What is the name of your state? SC
Last July, I had some lab work done, and I asked for a doctor that was in my network. The practice gave me a doctor that they said was in my network. Unfortunately, he was not.
After getting my bill, I talked to the receptionist. She said that, at the time, they were in the process of credentialing (?) my doctor, and that my insurance company (IC) was paying at that time. She said that they were telling people that my IC was ok, but it was not. She said she would re-bill through their lab, which should take care of the problem. Unfortunately, I kept getting bills.
Next, I talked to someone in the billing office. She said my IC should have paid, because my doctor was in the network at the time. (My IC denies that.) She said she would re-bill, but I got another bill the next month. This time, she said she would talk to the owner of the practice, but she did not think there would be a problem clearing this up.
Next month, another bill. I told the lady in billing that I was concerned that this would get turned over to collections. She assured me that this would not happen, because they do not turn their medical bills over to collections. She said she would send me an e-mail explaining this, but she never sent it. I think she is just trying to stall me long enough so it DOES go do collections.
I keep getting bills, and the same billing lady keeps giving me the runaround. Last time, she said she talked to the owner’s wife, who told her to charge this off. I got another bill this month, though!
Also, I want this charge completely removed from my bill. Won’t a “charge off” show up as a failure to pay?
So, I am 120 days past due, and I am starting to get late fees. What should I do?
Does the numerous confirmations that they told me my doctor was in my network but he really wasn’t give me any protection? Will I still eventually have to pay? Will this go to collections?
I drafted a letter that explains what I have just written. I am planning on having it notorized and then sending it to the head of the billing department via certified mail. Is this a good idea? Will this give me some protection?
Does the fact that I was misled about my doctor being in my network even matter at all?
Should I pay the bill and then sue for reimbursement in small claims court? If so, could I sue for court costs, time off of work, and other damages?
I would appreciate a prompt reply, as I believe I could be turned over to collections within the next week or two.
Thanks in advance!
Answer
Try to have a 3-way conference with IC, billing and you. This may take care of it. Also, if you have no luck with billing lady, ask for her supervisor, and then for the owner if needed. This is entirely their fault, and not yours.
Answer
How much is the bill in question?
Answer
Why the heck would she want to stall until the bill does go to collections? They get less money that way.
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This is entirely their fault, and not yours.
Sorry, that is untrue. It is not the health provider's responsibility to interpret someone's health insurance policy. It is the subscriber's responsibility; it says so right in the policy.
OP, pay the bill and pursue reimbursement from the insurer yourself later. The only thing that will happen if you wait is you'll accrue more interest, late charges, and ruin your credit.
Answer
Purple 2 is correct.
It is YOUR insurance policy - and the patient is always liable for bills. a lot of Hospitals bill as a courtesy plus they get paid faster that way.
You are the guarantor- you signed a piece of paper at sign in of the appointment that guaranteed payment.
You need to pay this and go after your carrier for reimbursement.
I can not see a provider letting you go to collections, as previously stated, we providers get less money because we have to split any money collected with the collections agency used. They get a commission, so it is always in the providers office to get the money themselves!
Answer
What is the name of your state? SC
drafted a letter that explains what I have just written. I am planning on having it notorized and then sending it to the head of the billing department via certified mail. Is this a good idea? Will this give me some protection?
Thanks in advance!
No, having a notarized letter is not going to do squat for you
Answer
Ablessin, Purple, are you guys for real? You seem to live in a parallel universe, where simple stuff does not work and it's always OP's fault.
If you cared to read carefully, OP had asked for a doctor in network, and he got one that was not. That's not his fault, and he has the right to not pay the charges. Where I live things like that get worked out between me, hospital and insurance. I never had to pay collectors and always had it worked out.
Answer
The response given by ablessin & purple was on target (as usual). Perhaps it is you who live in a different world.
If the OP wants to continue to stall, that is their choice. They can argue all day that they were misled, but it does not absolve them of the responsibility for the bill.
While they are procrastinating on principle, their credit is being damaged.
Of course the OP has yet to indicate how much money is involved here.
Answer
Thank you, Somarco.
The OP still had legitimate services, whether or not they were rendered by an "in-network" provider.
So, if the OP knew would they have skipped the procedure (labwork)? I mean, how important was it? Generally speaking, lab work is not super costly. Although it does depend on a few factors. Was it a fairly common and simple test? Those are usually pretty cheap, and you are correct, the OP has not stated how much $$ they are fighting over.
The fact of the matter is, that some people just don't seem to "get" :
Insurance is the patient's - -NOT the providers. It is 99% of the time up to the patient to make things right. They are usually the ones who are supposed to make sure there is a referral in place before a specialist visit, etc.
The patient signs a form at the beginning of an office visit, hospital admission, etc - called a guarantee of payment -or something along those lines very similar. The patient is ultimately guaranteeing the provider payment - be it from the insurance or themselves.