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Medical Provider Wont Give Me Bill for Insurance and is Keeping My Money

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  • 09-01-2009, 06:57 PM
    ginger2
    Medical Provider Wont Give Me Bill for Insurance and is Keeping My Money
    My question involves collection proceedings in the State of: California.

    1) I received services from a medical provider (in network with my insurance co). They refuse to provide an invoice which I can use to bill my insurance company until I pay my bill in full. About half way through my treatment, I did pay them what they said was the full amount; then they gave me a bill which I sent to the insurance company but the rest of my treatment was another $1000. Shouldnt they give me a bill I can use to bill my insurance company to help cover the cost?

    2) The insurance company mistakenly sent them my check (made out to my name) to reimburse me for the services for which I already paid to the provider. The provider is refusing to give me the check until I pay for the rest of the services in full. Isnt this illegal of them to refuse to give me a check made out to me for services for which I already paid them? Thus, They are demanding that I put out the entire amount of the treatment before getting any insurance reimbursement.

    3) They are contracted in=-network but are charging many times the contracted rate. They did give me long sessions but they will give me no accounting for how they are figuring the bill. Shouldnt I get the contracted rate for the contracted services and dont I have a right to know what it is?

    4) With the one and only bill I got was a threat to send my account to collections within one month if I did not pay in full, and they have called to reaffirm this. I received the services and want to pay what I legitimately owe but I feel I am being treated shabbily and like a deadbeat.
  • 09-01-2009, 07:11 PM
    jk
    Re: Medical Provider Wont Give Me Bill for Insurance and is Keeping My Money
    why are you having to do all of this if the provider is an in network provider?

    where is your insurance company in all of this?


    Quote:

    1) I received services from a medical provider (in network with my insurance co). They refuse to provide an invoice which I can use to bill my insurance company until I pay my bill in full. About half way through my treatment, I did pay them what they said was the full amount; then they gave me a bill which I sent to the insurance company but the rest of my treatment was another $1000. Shouldnt they give me a bill I can use to bill my insurance company to help cover the cost?
    how are you paying anything unless they are billing you?


    Quote:

    2) The insurance company mistakenly sent them my check (made out to my name) to reimburse me for the services for which I already paid to the provider. The provider is refusing to give me the check until I pay for the rest of the services in full. Isnt this illegal of them to refuse to give me a check made out to me for services for which I already paid them? Thus, They are demanding that I put out the entire amount of the treatment before getting any insurance reimbursement.
    then call your insurance company and tell them the check was apparently mistakenly sent to the provider instead of you. See if they will cancel the check and reissue a new one.

    Quote:

    3) They are contracted in=-network but are charging many times the contracted rate. They did give me long sessions but they will give me no accounting for how they are figuring the bill. Shouldnt I get the contracted rate for the contracted services and dont I have a right to know what it is
    again, where is your insurance company in this. The contract is between the provider and the insurance company and they should be dealing with this.

    Quote:

    4) With the one and only bill I got was a threat to send my account to collections within one month if I did not pay in full, and they have called to reaffirm this. I received the services and want to pay what I legitimately owe but I feel I am being treated shabbily and like a deadbeat.
    so tell them you have no way of determining what you owe unless they send you a bill.
  • 09-02-2009, 09:10 AM
    lealea1005
    Re: Medical Provider Wont Give Me Bill for Insurance and is Keeping My Money
    Was the service you received considered medically necessary or cosmetic?

    Was the procedure/treatment you received a covered service? Deductible? If they were not a covered service, the provider (in network or not) can charge and collect their normal fee for the service.

    Unless you have a written agreement which states otherwise, the provider expects and deserves payment at the time of service. Go in person with your payment and ask for your check and a detailed receipt that you can submit.

    I'd also like to know....if they are network providers...why you are responsible for submitting your claims. That just sounds screwy. The provider is usually required to submit claims if they are contracted with your insurance company.
  • 09-05-2009, 03:07 PM
    ginger2
    Re: Medical Provider Wont Give Me Bill for Insurance and is Keeping My Money
    I finally got through to someone in the insurance company who did say they will deal with part of this so I hope they do. The service was considered medically necessary; however, I think I had more than the authorized number of visits. (The insurers policy about additional visits is that they refuse to preauth- you had to submit bill, they refuse, then you appeal based on medical necessity and since I dont have the bill to submit, I couldnt even get going with this.)
  • 09-05-2009, 06:18 PM
    jk
    Re: Medical Provider Wont Give Me Bill for Insurance and is Keeping My Money
    hopefully it will all work out in the end.

    thanks for the update.
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