Good morning all!
I have a situation that is really getting my goat! I awoke this morning with it making me cuss out loud.
I recently had to get a copy of all the payments I have made to my doctor over the past year. The receptionist, bless her heart, showed me the section that I paid, then showed me where my insurance had paid. Well, I have two types of insurance, and when one doesn't pay, the other is supposed to pick up the difference. A while back, I was told that they no longer accepted the secondary, and my office visits were going to be costing me $52 more per month. I reluctantly wrote out the check every month because I am on a limited income and it really cut into grocery money. Then, she told me that they HAD been accepting payments from the insurance AND me. When she told me this, she said she would do what she could to get me my money back. Now, the billing lady is hem-hawing around, and not refunding my money. Since they are billing me, and the insurance company, is this considered insurance fraud? Should I call the "On Your Side" TV station? Consumer Affairs? The BBB? Some sort of medical ethics board?
HELP!!!
C. M.
Thank you all for your advice. I was very persistent with the billing assistant at my Doctor's office, and they finally refunded me the entire amount I had paid over the past year. It was a healthy check, and there was no need to contact an agency of any kind. Thanks to Mamasource members, I was calmed in my initial anger, and able to be level-headed about making my request to the office manager.
Thanks again,
C.
If you're in the Jacksonville area you could call Ken Amaro at First Coast News.
____@____.com
http://www.firstcoastnews.com/inside/contactus/news-artic...
Hi C.,
Unfortunately no, your situation would not be considered insurance fraud. However, it is unethical and with that being said, the Better Business Bureau would be the association to contact. If they do not respond in a timely manner, then of course I would suggest contacting an "On Your Side" program. Best of Luck.
I worked for a doctors office for a long time and did the billing and insurance. I dont think this qualifies as insurance fraud (they could say oh we were just getting around to refunding her....), but they certainly should not be accepting money from your insurance company and not refunding you in a timely manner. Are they a participating provider with your secondary insurance? If not, they should not be filing it, and the insurance company should not be sending them money. I would call the insurance company and ask them not to send any more money to this physician (unless of course they do have a contract with your physician, in which case they have to send him the money, but if that is the case, your physicians office is LEGALLY not allowed to take your money unless they KNOW you will owe a copay or deductible). I would also call the doctors office and tell them if you dont have a check in your hand within such and such days, you will be calling the insucance commissioner. Better yet, give/send them a letter in writing, so you have proof. All the little rules and regulations that govern insurance companies and doctors offices can be complicated, but bottom line is they have YOUR money and they need to give it back. (I would say no on calling the news or anything unless you cant get them to return your money, and if you do that, you should have put your request in writing to the docotrs office so you can say see, I asked for it back and they wouldnt comply...) I hope that helps, let me know if you have any more questions because I spent a lot of time doing this job!
Something similiar happened to us, but we were able to resolve it through our insurance company.
However, if your doctor accepts payment from the insurance company, he is not allowed to accept money from you. If your insurance hadn't paid, it would be a different story. Thus, if you paid in full, then they aren't allowed to then take from the insurance company and in turn you get reimbursed through your insurance, not the doctor.
I would definately call someone on this, especially since you're on a fixed income. It's called double dipping and it's fraud. Better Business Buerau can't get your money back so I reccomend going with someone who can.
Also, you can obtain records of payments from your insurance company.
Sounds like the billing department knew how to screw you to begin with by saying the rejected your secondary. Call on your side. They'll figure it out for you! :O)
C.,
I would contact your insurance company first and see what they say. Then let your doctor's office know that you did. Sometimes if they think their payments could be on hold they seem to work faster.
A.
I would start by calling the insurance company. They may be able to point you in the right direction as to which local/state/federal agency to call. This is insurance fraud, but if it was a mistake they should be giving you your money back with no hassles
Do yourself a favor and call and report this to your secondary insurance. Let thier lawyers fight for you.
