19 answers

Problem with a Bill from Dr, Is There Anything I Can Do?

I went to my dr and told him about a mole on my scalp that would bleed every now and then. He said he could remove it no problem and I told him I was concerned about what my insurance would cover. He asked his nurse to have the front desk call and find out, the nurse came back in and said it would be a co pay of $25 and that would cover up to 9 moles/skin tags being removed. After the appt I set up an appt for the procedure and asked again if this info was correct and was told yes by the receptionist. A month later I went in had the procedure done and during it the dr said if it covers up to 9 he would remove another mole I had and some skin tags. A month later I get a bill for $200. This bill has the mole removal, cosmetic surgery and emergency surgey that was not pre planned on it! Now I know I should have contacted my own insurance... well at least I know that now! Im young and inexperienced with these things. I assumed that they contacted and got true information since I asked about it twice. Plus I never mentioned wanting anything removed but the one mole the rest was the dr's idea. And the procedure was pre planned. I feel like they gave me a price and thru in some extras, I paid that price and now they aren't honoring it. I went in today (i have bronchitis) and they refused to see me until I paid the full amount. I have contacted the billing dept, which is a seperate business in a different state, they say that they have to bill what the dr send them and that I need to talk to the dr. I have called the dr's office countless times and they say someone will call me but noone ever does. Im thinking of writing a letter explaining everything and mailing it so maybe someone will read and understand what happened. Is there anything I can do here?? Any advice would be helpful bc I cant afford another dr's bill!

1 mom found this helpful

What can I do next?

So What Happened?™

Well I did see another dr and got meds for my bronchitis. I won't be going back to my normal family dr. I wrote a letter to the billing dept, dr and office manager explaining the situation since they will not return my calls and I sent them a check for $10 so they will slowly be getting paid. It frustrates me bc I have refferred this dr to many friends. UGH I hate feeling like Im getting ran over and can't do much about it!

Featured Answers

Step One. Change Dr.s
Step Two. Pay the Bill over time put 2 quarters in a jar daily send the amt off monthly (15/month will take 13/14 months to pay off)
Step Three. File under LESSONS LEARNED.

1 mom found this helpful

More Answers

The $200 may have been your calendar year deductible. A lot of plans have a set deductible amount which must be paid out of pocket before the insurance coverage kicks in. It's very possible that the doctor's receptionist told you correct information, under the assumption that your annual deductible had already been met. There would be no way for them to know how much had been previously paid towards your deductible ceiling from previous doctors visits in the year.

And of course, now that we're in January, most insurance plans' deductibles have been reset to zero for the 2011 calendar year.

You really need to contact your insurance and have them explain how your coverage works and whether you have an out of pocket deductible to contend with.

And as mentioned by other posters, you ought to set up a payment plan before this bill goes to a collection agency--which will increase the amount due because they add on penalties and collection fees. And you really don't want this impacting your credit history for the next 10 years.

7 moms found this helpful

Your first step is to call your insurance company and see why they didn't pay the bill. 9 out of 10 times it is a billing code that was put in incorrectly by the doctor's offices.
My husband works for a big insurance company (and used to write the coverage books), and he says that most billing issues have to do with coding errors.
Just be nice and be persistent. You may even need to ask the insurance company what code should have been used and then call the doctor's billing person and tell them what code to put in and to please resubmit the bill.
Hope that makes sense and good luck,
R.

3 moms found this helpful

Sounds like they checked what would be covered but did not schedule/get authorization for the procedure. They wouldn't necessarily do both at the same time but rather wait until you had agreed to the procedure. They should have done that and you should have verified it was done.

You need to speak to the doctor because they should have billed it as pre-planned not Emergency but if it wasn't pre-authorized w/ the insurance company then they would still most likely considered it Emergency surgery.

You should also speak to the insurance company and explain that your doctor's office called to verify what would be covered and you scheduled your appt at that time. Ask what you can do at this point.

2 moms found this helpful

what they mean by preplanned: alot of insurance companies require you to get approval through them before having certain procedures done. since you didnt call to tell them about it they dont have to cover it. dumb yes, but its pry in that fine print in your insurance plan

2 moms found this helpful

As far as the original bill, the doctors office is not responsible for knowing how much your insurance is going to charge...that is your job. The insurance company probably wanted you to make prior arrangements with THEM about having the mole removed...that is why you are seeing the "emergency surgery" bill. Contact the billing deparment again and ask them about setting up a payment schedule...and if your bill is being taken care of in a timely manner then there is no reason that the doctor shouldnt be willing to see you again.
They are probably refusing to see you because you are challanging the bill and not making payments. A doctors office is a business and they are in business to make a profit...I am sure he is bound by the rules that the group that he works for have enforced and he has no choice in the manner.

2 moms found this helpful

At this point, I would first call your Doctor's office and ask for the Office Manager. If you get her VM; then leave a message. Not just "would you call me back and a number"; but instead My name is XXX. My DOB is XXX. My Phone Number is XXX. I am calling in regards to a procedure that was done on XXX by Dr. XXX. I am disputing the charges. Before summiting an appeal through my insurance company; I wanted to speak to you. Would you call me back within the next business day so that we can try to resolve the matter." This usually works. Then explain to her what happened. They do not want any argument or disruption with the insurance company because they do not want complaints/investigations and the chance of loosing the contract. If the wavier and consent for treatment you sign does not outline the procedure they did with proper billing; it will be resolved so quick, your head will fly. Now as far as refusal for treatment. Are they your primary and therefore the only people you can see? If so, you may have to go to urgent care this PM. Good Luck!

2 moms found this helpful

Step One. Change Dr.s
Step Two. Pay the Bill over time put 2 quarters in a jar daily send the amt off monthly (15/month will take 13/14 months to pay off)
Step Three. File under LESSONS LEARNED.

1 mom found this helpful

Call and ask to speak to the office manager at your doctor's office and tell him or her what happened. If you don't get a return phone call within 24 hours, go to the office in person and ask to speak to him/her.

As long as you're making payments on the bill in a timely manner they should not refuse to see you.

1 mom found this helpful

You need to change drs!! No doctor that had a bill outstanding in my name has refused to see me. Second, you should be seeing a demotologist for moles, not a family doc. Call your insurance to find out what charges aren't covered. I had a dentist do this to me once. They said that I still had $432 left on my dental insurance. I didn't. I should have checked it myself. I ended up owing them $400.

1 mom found this helpful

Definitely change doctors. You should document everything and only correspond in writing from now on. I would report this doctor to the medical board and also contact your state attorney general about fraudulent billing practices. You should also tell your insurance company that you feel that he is fraudulently billing his customers. If he is billing your insurance company for procedures that are covered, but not performed, they will want to know about it too. Maybe after all that, your doctor will call you back and your bill will miraculously shrink or disappear. Just don't ignore the bill, because if he takes you to collections, it could destroy your credit history.

1 mom found this helpful

Keep trying to get a hold of the Dr. If you have to send a letter, do so, but don't stop calling. In the meantime find a new Dr., any Dr. who refuses to see you for treatment for not paying a previous bill is not a great Dr in my eyes. I have had procedures rack up and it took time to pay the Dr. but he never stopped seeing my family while I owed him.

1 mom found this helpful

First and most importantly, find another doctor and get seen for your current condition.

You should have received an EOB (Explaination of Benefits) from your insurance company. This would show the procedures, the amount billed, the amount covered by insurance, and the amout your responsible for. If there is an error, or you didn't receive one, call your insurance company to obtain the information.

Then write a letter to the doctor's billing dept and send a copy to the doctor. Be very clear and detailed. Give dates, names of people who you talked to, etc. Then state plain and simple that you have a verbal contact to pay the $25 copay which you paid and you have no intention of paying anything additional. Be sure you keep a copy of this.

1 mom found this helpful

The doc should see you regardless, that's not right. But sometimes the doctors billings office will send you the bill before the insurance approval has come through. You do have time to wait for that to happen and they will send you another bill if the insurance doesn't come through. So I would wait until the next bill comes. My mom has worked in medical billing for 16 years so I know a few things but I'll try and talk to her tomorrow and if I learn something new I'll post it! Good luck!

1 mom found this helpful

Contact the insurance company and ask them why they aren't covering your proceedures like promised. They like to refuse things the first time around. Then you need to call your Dr.'s billing department and tell them to resubmit to the insurance.

1 mom found this helpful

I would call and talk to your insurance company and explain it to them.. I had an issue with a doctors office and could not get the doctors office to help. I finally called my insurance company and they called the doctor on three way with me on the phone. It was amazing how quick the issue got fixed, the doctors office was eager to help then!

1 mom found this helpful

It reminds me of something that happened to me years ago. Let's face it, some people are milking the system and do shady things. I'd call the insurance co., tell them what happened and find out what exactly you are covered for. And ask them to direct you to a different doctor.

First, get a new doctor! Immediately! Then get seen for your bronchitis.

Then, call your insurance company. Explain the situation and ask what they need. Once you have that information call the billing department back. If you then need to speak to the doctor call him. If he doesn't call you back call every hour until he does. Since he's not your doctor anymore you have nothing to lose. If he still doesn't talk to you call the billing department again and tell them the doctor refuses to speak to you and ask if a supervisor will call him for you.
Explain to them that insurance should be covering this and that you won't pay it. You are doing your due-diligence and they need to help you if they want to get paid.

They shouldn't refuse to see you, especially if you have a payment arrangement. When you call an insurance company they have a disclaimer stating that benefits quoted are not a guarantee, final decisions will be made when the claim is received. The insurance uses three factors when deciding what categories a visit or procedure falls under: procedure code or CPT code, diagnosis code(s), and notes from the doctor. A mole removal procedure is probably coded as minor outpatient surgery, I would believe it's the diagnosis they used or the notes that led them to believe it was a cosmetic or elective procedure. Ask the doctor which codes he gave the billing service, or if the billing service codes based on the notes. Let him know what happened personally, I'm sure it can be corrected and rebilled to everyone's satisfaction. I wouldn't necessarily switch doctors if they're good, especially if they are willing to fix this situation.

Sorry, I realize I am waaay late on this, I hope you receive it. The doctor's staff acted on his/your behalf and you were told the details (co-pay of $25 and up to nine moles). I see physicians, and their billing questions, all day long (I work for a laboratory) and most of the issues come from someone in the office putting down the incorrect ICD-9 code (Diagnosis) or wrong test codes. These can be resubmitted!! It bothers me to no end when telephone calls are not returned, give us an update. Make some time when you know all the key players will be there, just show up...it's much more difficult to hand up on a human standing there. Make sure you have your paperwork with you and talk to the insurance company ahead of time to see the codes he used and if they were appropriate.

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