So pissed at insurance...

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actingnurse1
actingnurse1 Posts: 153 Member
in Motivation and Support
Didn't see a VENT section so hopefully this is ok to post here.. had to grype lol..

Ok so... to have my surgery I had to pay the cash price for the assisting doctor which was $ 400.00 and was guaranteed that once insurance paid his fee then I would be reimbursed the $ 400.00. So I call my surgeons office today since I knew they had been paid from my insurance company. They proceed to tell me that I owe them money... They couldn't explain why and would call me back tomorrow on that. I owe them the money AFTER keeping my $ 400.00. My insurance paid everything it was supposed to! If they refuse to reimburse me then I'm canceling my follow ups for the rest of the year which should cost them roughly a grand and will follow up with someone else. In the words of Sweet Brown, "Ain't nobody got time for that!!"

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  • morris76058
    morris76058 Posts: 17 Member
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    I would be mad too! Hopefully its just an accounting error. Let us know when you hear back!
  • tsdaughe
    tsdaughe Posts: 88
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    I would ask for a detailed bill from the surgeons office as well as the claim from your insurance. Most are all online now or can be requested by an automated system over the phone. Then compare the two. I have had doctors try to charge me for what insurance won't pay since it is over the contracted amount even though they are not supposed to do that. Or I have had doctors not bill using the right code or for the wrong amount and try to stick me with the bill. Or insurance made a mistake on their end. 1 year after I had my daughter the hospital turned 1,000 over to collections in my name after my insurance already gave them $1500. They claimed they sent me a bill and I never paid yet I never recieved a bill. Come to find out, they "accidentally" billed my insurance the wrong amount and had just sent the new amount to my insurance 2 weeks before sending me to collections for a bill I knew nothing about. My insurance company handled it and the bill dissapeared. Hope it works out.
  • actingnurse1
    actingnurse1 Posts: 153 Member
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    So after talking to the lady in the insurance billing at the surgeons office - she basically said they are holding the $ 400.00 because the insurance company has never approved as much as they did for the assistant for me. I told her flat out my policy ALLOWS 25% of the surgeons billable rate which is actually MORE than they billed for him. She was all like "so if we refunded the money and then the insurance company comes back at the end of the year on an audit and voids the payment because they overpaid will you pay for it?" - I said I can't pay 1100 at once but I would monthly. So yeah... they're holding it hostage b/c my insurance company paid. WTF.
  • actingnurse1
    actingnurse1 Posts: 153 Member
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    And about the title - Actually my issue isnt with insurance... it's with the Surgeon's office. Mistyped was in a hurry.
  • yallcallmedeb
    yallcallmedeb Posts: 294
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    Sounds like a call to the insurance company is in order. It sounds to me like the surgeon's office is violating their contract with the insurance company and I'm sure that the company would like to know :)

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