How to fight with Dr's office over insurance claim?

trianglejohnNovember 16, 2009

In a nutshell: I went to the Dr for a routine physical. From the appointment to take blood samples and the appointment to get the results my health insurance changed. Though co-workers were able to be recognized by the new provider, I was not. I paid the fee out of pocket and filed a claim myself. The claim was denied. I fought with the insurance company and got it paid (only partially) but they sent the check to the doctors office instead of to me! The doctors office wants to keep the check because they said they discounted my visit because I was paying myself instead of using insurance.

Their accountant won't return my calls. I've been calling since July and have gotten nowhere.

I keep explaining that the right thing to do is to send me the money or charge it back onto my credit card. That giving me the money is cheaper than keeping it because to keep it is to admit that I was covered by insurance which means that I am only liable for the $25 co-pay - and if you subtract that co-pay from what I've already paid they would have to return more money to me than what the insurance sent them.

I know I need another doctor - even though I like the doctor but I can't do business with these people. What I want to know is where do you turn for help in this sort of situation. The state Medical Board doesn't get involved with payment issues, only doctor misconduct. The insurance company wants nothing to do with it. I would love to go sit at their front door with protest sign but I can't afford the time off work.

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oilpainter

Take the doctor to small claims court if you are changing doctors anyway. Want to bet that the money will be forthcoming once he gets the court papers.

Set yourself up with a new doctor first and make sure you take every scrap of evidence you have even if you don't think it important, if and when you go to court. Document everything --dates of appointments, letters and phone calls to both the insurance company and the doctor, and any thing showing the doctor was paid by both you and the insurance company.

Before you set it up with small claims send a letter telling your doctor just what you are going to do if he won't come across with what's owing.

    Bookmark   November 16, 2009 at 9:30PM
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trianglejohn

Well, they saw things my way before it got ugly. The check is supposed to be mailed tomorrow.

    Bookmark   November 18, 2009 at 3:14PM
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