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

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