Medical Billing Question--where do I go now? (long)

[Beth76]

A few months ago I received a bill from my pediatrician. Looking at it I realized it was from my son's well visit from about 9 months before. What happened was it was paid by my insurance (in April 2005). Then in January (2006) my insurance company "took back" the payment. Why, I don't know. They couldn't even answer that question.

I called the insurance company and they said they would look into it. Several weeks later I hear from the doctor's billing department. I tell them that the insurance was looking into and I would call them again. So I call back the insurance and they said that a check was mailed out to the doctor (several months before) and cashed. They gave me check numbers and dates from when the payments were sent and when they were cashed. I called the doctor back and they said they never received the payment but they would talk with the insurance company.

I last dealt with this about a month ago. I thought it was all cleared up but today I received another bill. This is ridiculous. Obviously, the doctor claims to not have been paid by the insurance and the insurance claims to have paid them. Why am I stuck in the middle of this? What is my responsibility here? I don't know what else I can do.

 

[luvdzne]

As a person that has delt with several insurance problems you have my sympathy.

I would call the insurance co. back and talk to a supervisor. Tell them you want to know why they took back the payment. Tell them that you continue to receive a bill even thought you thought it was taken care of.

Are you sure well checks are covered under your insurance? When Dh got his job transfer last summer they switched insurance co. on us only to discover after it was too late that well checks are not covered after the age of 5 or 6. The insurance we have now is kind of strange as they will cover one well check in a time period. Like ages newborn-2, 3-5, 6-10. I still don't quite understand it. That may be the case with yours I don't know. However to have them pay and then take it back is very strange

 

[lowie]

A few months ago I received a bill from my pediatrician. Looking at it I realized it was from my son's well visit from about 9 months before. What happened was it was paid by my insurance (in April 2005). Then in January (2006) my insurance company "took back" the payment. Why, I don't know. They couldn't even answer that question.

I called the insurance company and they said they would look into it. Several weeks later I hear from the doctor's billing department. I tell them that the insurance was looking into and I would call them again. So I call back the insurance and they said that a check was mailed out to the doctor (several months before) and cashed. They gave me check numbers and dates from when the payments were sent and when they were cashed. I called the doctor back and they said they never received the payment but they would talk with the insurance company.

I last dealt with this about a month ago. I thought it was all cleared up but today I received another bill. This is ridiculous. Obviously, the doctor claims to not have been paid by the insurance and the insurance claims to have paid them. Why am I stuck in the middle of this? What is my responsibility here? I don't know what else I can do.

i would ask the insurance company of a copy of the cashed check and bring that IN PERSON to the doctors office and show them proof of payment and right there and then ask for a 'paid in full' receipt.
this shouldn't be your problem but you don't want to end up in collections either. good luck!

 

[Beth76]

Yes, well checks are covered. We've had several since then. That was only the initial problem as to why the payment was taken back. But the insurance company claims they paid the doctor back for this. That's the problem now that the insurance says they paid and the doctor says they never received the second payment.

 

[lsyorke]

If you insurance carrier covers your will visits(which it appears they do) AND they sent checks that were cashed by the doc, this is between the insurance and the doc. You could request copies of the cashed checks to prove this(if you want to end this), but it's really their responsibility.

 

[HaleyB]

I agree that you need to ask for a copy of the check the insurance company says the Doctor cashed. Bring it in person to the Doctor and see if that clears it up.

I also recommend you ask about this on the budget board. There are people there that know a lot about the fair billing laws and can tell you exactly what to put in a letter to protect yourself (and your credit score). If this does not clear up soon you need to send a letter to them (I think it is called a 'drop dead' letter).

I would also pull a credit report to make sure this is not already on your credit report.

I had the same thing (well not a well baby visit, an ER visit) going on for awhile here. I finally got it cleared up. They had credited the wrong account when my insurance company paid them!

 

[HERSEY]

Did the Insurance co actually send a check to the doctors office or an Electronic fund transfer. In either case insist the Insurance co contact the doctors office to clear this up. The Insurance co should be able to clear this up quickly. In this times, the Insurance doesn't issue individual checks but a "bulk check" with many insureds on it. They can't issue you a copy due to privacy issues but should contact the doctor's office on your behalf. Hope you get this resolved.

 

[BelleBoo&AmisMum]

Give your doctors office the customer service phone number to the insurance company and the check number that was sent to the office and tell them to sort it out amongst themselves. I actually get rude and tell the billing people that it's their job to do not mine and if they have a question for the insurance company they are more than capable of picking up a phone and calling.

Of course I did medical billing for 7 years before being a SAHM so any issues we have never last long.

 

[Beth76]

Give your doctors office the customer service phone number to the insurance company and the check number that was sent to the office and tell them to sort it out amongst themselves. I actually get rude and tell the billing people that it's their job to do not mine and if they have a question for the insurance company they are more than capable of picking up a phone and calling.

The last time I spoke with the doctor's office I did give them the check numbers and dates cashed. They said they would contact the insurance company. I guess I'll call again and tell them it's their job because it is after all. There's nothing I can do except keep calling these morons. Of course, it's difficult to know who's at fault here.

 

[spokanemom]

Since you are ultimately responsible for the bill, you will have to take care of this, sadly. I work for an insurance co, and my best advice is to call the insurance company and have them 3-way call with the dental office. They will be able to talk to each other and you will be able to make sure that the situation is resolved.

Good luck to you, I know it is really frustrating!

 

[Southern4sure]

A few months ago I received a bill from my pediatrician. Looking at it I realized it was from my son's well visit from about 9 months before. What happened was it was paid by my insurance (in April 2005). Then in January (2006) my insurance company "took back" the payment. Why, I don't know. They couldn't even answer that question.

I called the insurance company and they said they would look into it. Several weeks later I hear from the doctor's billing department. I tell them that the insurance was looking into and I would call them again. So I call back the insurance and they said that a check was mailed out to the doctor (several months before) and cashed. They gave me check numbers and dates from when the payments were sent and when they were cashed. I called the doctor back and they said they never received the payment but they would talk with the insurance company.

I last dealt with this about a month ago. I thought it was all cleared up but today I received another bill. This is ridiculous. Obviously, the doctor claims to not have been paid by the insurance and the insurance claims to have paid them. Why am I stuck in the middle of this? What is my responsibility here? I don't know what else I can do.

I feel for you. The exact same thing happened to me a few years back except about the taking a payment back. It reached a point that the Dr. office turned the account over to a collection agency (who was rude and hateful and tried scaring me). Our ins company also gave me the check #, amount, date and deposit date and even called the dr. office several times to try and settle the matter.

The dr. office refused to accept the fact that they were paid and they made a mistake on their end. I know I was stubborn but this went on for 1 year. The dr. office hired a new billings manager and she promised to investigate. They found the payment which was credited to someone elses account instead of ours.

I demanded a letter of apology for several reasons: 1) So if this error showed up on our credit report I would have written proof from the Dr. office of their mistake.
2) I just felt like I was owed an apology.

Don't cave in and pay the bill. There is a mistake and your dr. office should look for it.

Good Luck!

 

[bettyann29]

if its a matter where everyone cant get on the same page then I would call the insurance company and 3 way the call with the insurance person in the drs office.. I would get both names and first have the insurance company advise why they took the money back in the first place.. if its a matter where the insurance company is saying that they never recvd the money from the drs office but the drs office is insisting they sent it back then whoever generated the check (sounds like the drs office) needs to do a tracer on the check and find out if its been cashed and if so they can obtain a copy of the front and back from the bank.. then if they can provide proof that the insurance company recvd and cashed check than its up to the insurance company to find the money.. however the important part is why did they request the money back?? that alone sounds like they determined you owe this.. but maybe its an error

 

[Tink9748]

Since you are ultimately responsible for the bill, you will have to take care of this, sadly. I work for an insurance co, and my best advice is to call the insurance company and have them 3-way call with the dental office. They will be able to talk to each other and you will be able to make sure that the situation is resolved.

Good luck to you, I know it is really frustrating!

I also work for an insurance company and would agree with the above. If needed the provider can request a copy of the cashed check and see if they can figure out where they posted it.

 

[wilderness01]

spokanemom wrote:

Since you are ultimately responsible for the bill, you will have to take care of this, sadly. I work for an insurance co, and my best advice is to call the insurance company and have them 3-way call with the doctor's office. They will be able to talk to each other and you will be able to make sure that the situation is resolved.

This is absolutely correct. I have had this happen quite a few times and I was stuck in the middle. I said "it was their problem and they needed to deal with it" and they both let me know that it really was my problem/bill so I needed to make sure the issue was straightened out. Good luck. I was on a 3 way call one time for over an hour. I literally fell asleep listening to them talk and work it out.