Fighting with Dr Office - Hope I Did the Right Thing ?

Discussion in 'The Watercooler' started by DaisyFace, Jul 8, 2011.

  1. DaisyFace

    DaisyFace Love me...Love me not

    Well, if it's not one thing, it's another....

    I recently switched DS to a new pediatrician. I called Medicaid...called the previous doctor....thought I had everything switched over...

    And sure enough, when we got to the new office, they told me there was a problem with the Medicaid. The receptionist tried calling Medicaid to see if we could straighten it out right then and there, but she got stuck on hold..gave up...and hung up.

    The office has a policy NOT to see patients without payment up front or valid insurance info. Frustrated, I paid for the visit in full with my cc - and told them I would call later that day with the correct insurance info.

    They charged me a few hundred dollars.

    Later that day, I called Medicaid - got everything all straightened out - and called the doctor with the information. I asked for my cc to be refunded.

    They refused! They told me I need to bill medicaid directly and have them reimburse me for whatever I paid. Well, great! Medicaid does not work that way. I figured that was a few hundred dollars down the drain.

    Now - I get in the mail a BILL from that doctor's the tune of $1000 !!! They have not even given me credit for the few hundred that I already paid (which as supposedly the ENTIRE amount of the visit!!!)

    So...I wrote a letter to the doctor's office asking them to please bill Medicaid directly.

    And then I called the cc company and disputed the original charge for the visit.

    Do you think I did the right thing?
  2. susiestar

    susiestar Roll With It

    yup. doctor office is hosing you. Here they will ALL just bill medicaid later. If the visit is the date of service it was worked out then it will go through for them. Heck, pharmacies here will re-imburse you up to 3 mos later if you catch they they got paid for something that you paid for. And they CAN go and get it worked out to cover this visit. Also, unelss the doctor spent an hour with you, the visit shoudl NOT be that high. A normal visit is $100 herem $155 for new patientss. Period. At any doctor that takes medicaid. If nothing else, cry poverty and ask them to reduce the amt. Our hospital and docs will reduce a visit to the copay of medicaid a LOT of times (most docs here) - and that is $3 for adults.
  3. DaisyFace

    DaisyFace Love me...Love me not

    Thanks, Susie!

    Yes - "Hosing" is the word.

    And frankly, if they weren't willing to bill Medicaid for this visit and just wanted to keep my money - I probably would have let it go.

    But now that they are trying to bill me this outrageous amount? Now I am TICKED!
  4. TeDo

    TeDo Guest

    Absolutely. You aren't the one that refused to wait for an answer from your insurance carrier. You did everything you were supposed to do BEFORE the appointment. You paid the amount they told you PRIOR to the appointment. There is nothing else you could have done. I would make a BIG stink about it.
  5. slsh

    slsh member since 1999

    Daisy - I think if they accept Medicaid, they are *required* to file claims. I've never heard of a person filing a claim with- Medicaid to get reimbursed. I'd call your state Medicaid office. This could possibly be a dr. office trying to get out of accepting Medicaid's lower reimbursement rates. Glad you canceled the charge on cc, and definitely - just send ins. info back with their bill.
  6. 1905

    1905 Well-Known Member

    Call the Dept. of Banking and Insurance in your state, get the address, send them the bill, tel them your "story" as briefly as possible. They will fix it immediately for you. Once a dr. office never sent a bill to my ins co for about 2 years, well my ins. won't pay after 1 year, so they wouldn't pay. Suddenly, 2 years later they said I was responsible for it, but they had never sent me a bill either. So, OH NO THEY WERE'NT, I sent all my info and about a week later someone called me from the Dept of Banking and Insurance and said it's taken care of, and to call them if I get another bill from them. I didn't. Don't worry, the Dr. is trying to get all the money he can, but you're not responsible!
  7. shellyd67

    shellyd67 Active Member

    Yep, you sure did the right thing.

    I did private practice medical billing for many years. Fact is, your cc pymt was probably more than Medicaid would have paid for the entire bill and that is why they are giving you grief over it.

    If your DS is eligible for Medicaid they MUST bill Medicaid.

    The Dr's office does all the direct billing for office visits and everything must be billed electronically.

    Now that you have disputed the charge with your cc company, just inform the office that if they bill for the visit they will get paid. IF not, they won't !

    I can understand that they could not verify coverage and they cannot "take the chance" of not getting paid, however now that cov'g is verified they can shoot a bill over in the blink of an eye.

    Good Luck and I hope you get your refund.
    I am actually going to PM you about something else later on. Shelly
    Last edited: Jul 8, 2011
  8. AnnieO

    AnnieO Shooting from the Hip

    Medicaid? HAHAHAHA!

    OK, here - we tried to get Medicaid to reimburse us for expenses when we did not know the kids were covered - and they said the would only reimburse BM, and she could pay us.

    We ate the money. Seriously, her pay us?
  9. flutterby

    flutterby Fly away!

    In Ohio (don't know if it's the same everywhere, but I imagine it is), if a doctor or medical facility takes you knowing you have medicaid, they cannot bill you for anything - even if medicaid denies coverage. For example, when I was supposed to go to the Cleveland Clinic, medicaid required prior authorization but my (former) neuro didn't get it. If Cleveland Clinic had seen me (I had an appointment), they couldn't charge me even though medicaid would not cover the visit, because they knew I had medicaid when they scheduled. Didn't matter that the neuro's office dropped the ball and didn't get the prior auth.

    So, I'm wondering if the pediatrician's office was even allowed to charge you that few hundred dollars when they did. I would be calling your medicaid provider or social services worker to find out.
  10. flutterby

    flutterby Fly away!

    Not provider - that's not the right word. Call whoever manages your medicaid.
  11. TerryJ2

    TerryJ2 Well-Known Member

    So sorry they're being $%(*@@*s.