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  1. #11
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    Default Re: Patient Taking Office Manager to Small Claims Court

    I don't dispute that if this were a Medicare claim, which it is not, the participating provider would be obligated to comply with Medicare regulations related to patient debt. I don't dispute that there may be a contractual provision with the insurance company that requires that they bill a patient for deductibles and copays. But my question was in relation to the suggestion that such billing is required (a) in this case (b) by law.

  2. #12
    Join Date
    Oct 2011
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    9

    Default Re: Patient Taking Office Manager to Small Claims Court

    Yes, Medicare does have such a requirement. I was under the impression it was true for private pay as well. Wouldn't it be true that, if you did not attempt to collec the patient portion, then you "actual" fee would be what the insurer paid and not what was billed, thereby creating a dual fee schedule and, perhaps, committing fraud (by billing a fee higher than your "real" fee)?

  3. #13
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    Oct 2006
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    818

    Default Re: Patient Taking Office Manager to Small Claims Court

    In general, many insurance companies follow Medicare/CMS regs when contracting with Physicians. Checking at least 2 of our contracts I find similar paragraphs stating a "good faith" effort to collect must be made in the form of at least 3 written attempts before it could be considered bad debt. When purchasing the policy, the subsciber agrees to remit all co-payments/co-insurance/deductibles within 30 days of service.

    As for your specific question, I guess you're right, if it BC/BS it's contractual, not by law. That's why you're Knowitall!

  4. #14
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    Oct 2011
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    Default Re: Patient Taking Office Manager to Small Claims Court

    However, in addition to contractual obligations, there are usually statutes as well... to control non-participating docs from having dual fee schedules.

  5. #15
    Join Date
    Feb 2010
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    CT & IL
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    5,273

    Default Re: Patient Taking Office Manager to Small Claims Court

    Quote Quoting lealea1005
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    Hmmm....but don't you have to pay the mechanic BEFORE you are given back the keys to your car? Just saying.
    I don't -- I pay after I examine the work that was completed. Do you pay before you know if they fixed the problem? Different strokes for different folks.

    For things I cannot check, I do pay ... if a problem is discovered later then I deal with it. In last 10 yrs I have seen a doctor (well, visited a Dr office -- they left me in their examination room and went to lunch, no kidding) once and my cars have seen a mechanics wrench once (I do all repairs on my car).

    I have to see a dentists this week though, cracked a tooth & my plaster repair failed along with my duct tape fix ... But I'll get a price before the work begins.

  6. #16
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    Default Re: Patient Taking Office Manager to Small Claims Court

    Quote Quoting RetiredOM
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    However, in addition to contractual obligations, there are usually statutes as well... to control non-participating docs from having dual fee schedules.
    Some states have them more globally, others in more of a patchwork style; it makes sense to know and understand the laws of your state. Did you find any such provision in the Virginia Code?

  7. #17
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    Default Re: Patient Taking Office Manager to Small Claims Court

    In last 10 yrs I have seen a doctor (well, visited a Dr office -- they left me in their examination room and went to lunch, no kidding)..
    Ridiculous! Hope you have better luck with a new Doctor. I've been a Practice Manager for 20+ years and can assure you that wouldn't happen where I work. That total lack of respect for a patient and their time ticks me off.

    I have to see a dentists this week though, cracked a tooth & my plaster repair failed along with my duct tape fix ... But I'll get a price before the work begins.
    Owww and lol. Well, they say duct tape fixes almost everything. You'll get an "estimate" before work begins.....unforeseen things may happen during the procedure. Good luck.

  8. #18
    Join Date
    Feb 2010
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    CT & IL
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    Default Re: Patient Taking Office Manager to Small Claims Court

    Quote Quoting lealea1005
    View Post
    Ridiculous! Hope you have better luck with a new Doctor. I've been a Practice Manager for 20+ years and can assure you that wouldn't happen where I work. That total lack of respect for a patient and their time ticks me off.
    .
    I was in the exam room 1 hr and finally went out to see whats what. The nurse said "they went to lunch" .. I think it was done in error of course and told them not to send me a bill. Its the only time that this has happened to me. Lucky it wasn't at the end of the day & they locked me in lol ... if it was I would have laid out near the door on the ground pretending to be dead the next morning.

  9. #19
    Join Date
    Oct 2011
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    9

    Default Re: Patient Taking Office Manager to Small Claims Court

    I never did find a state statute (which is why I came to this forum in the first place... hoping someone on here would know where to find it, if it exists). However, just to let you know... the judge dismissed the case. All is well.

  10. #20
    Join Date
    Oct 2006
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    supratentorial region
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    818

    Default Re: Patient Taking Office Manager to Small Claims Court

    Glad all went well for you.

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