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  1. #1
    TNUtammy is offline Junior Member
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    Disputing a Medical Bill

    What is the name of your state (only U.S. law)? Tennessee

    First of all, I would like to apologize for the double post. I think most regular members are aware of the problem last night with all posts ending up in the Auto Accidents forum instead of where they were intended. I feel it necessary to repost my question in the correct forum because I don't think I am getting the right answers due to the problem. Thanks in advance.

    Original Question: Can I dispute a medical bill if my doctor's staff lied to a disability insurance company?

    I have been having trouble for over a year now with trying to get a short term disability case approved by Cigna. There have been several issues with the way my case has been handled, both by Cigna and the doctor who originally approved my leave of absence from work.

    My case has been denied twice now by Cigna, so this time I requested my complete case file from them before sending in my 3rd and final appeal. What I found in my file about what my doctor's staff told Cigna completely threw me for a loop.

    The receptionist who took the call actually told Cigna that my doctor 1.) did not take me out of work, 2.) did not list any work-related restrictions, and 3.) wrote in my file that I did not have any severe symptoms.

    Obviously this is the reason why my case was denied, despite the fact that the office notes written by my doctor about this visit state the exact opposite! My doctor DID take me out of work, DID state that I could not function at work, and DID list my severe symptoms.

    When I went back to the facility (several times) asking that they send in a statement proving this, they outright refused. I have been unable to pay off the rest of my medical bill to this facility because I have not yet been paid by Cigna.

    I highly doubt that I am ever going to receive my disibility pay from Cigna because the doctor and their staff will not send anything else in. Now my doctor's office is threatening to send my account to collections, but it is actually their fault that I do not have the money to pay the bill in the first place.

    I plan to dispute the remaining bill, about $80 (I know it's not that much but I really do not think I should have to pay for the trouble they have caused me, not to mention the fact that they have cost me 3 months of pay).

    Does anyone know if it is possible to successfully dispute this kind of thing? I know that you can dispute whether or not the bill is yours, but what about disputing that you did not receive the service promised to you? In fact, the facility in question has been very counterproductive to my cause (which is a difficult case in itself).

    I would really appreciate any answers about a similar experience or insight into the process for filing a dispute. I am going to send a letter to the doctor's office and hope that it doesn't go to collections, but if it does then I will need information about how to proceed.

    I would also prefer to do this without paying for a lawsuit. Even if I won the case, I would probably only recover the 3 months of pay I lost and then end up giving it right back to the attorney to pay my fees. However, I would be open to requesting a mediator or state funded attourney if there is a chance that I could recover the 3 months of pay I should have been entitled to.

    Thanks.
  2. #2
    TNUtammy is offline Junior Member
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    Just in case anyone is paying attention or in a similar situation and needing answers, I checked a few other resources and was able to find out about some more options.

    My account has not yet gone to collections so I am sending a letter (along with the documentation I have) to the billing department of the medical office where this happened. I am going to request that they cancel the remaining balance on my account due to the trouble they have caused me, not to mention the extra office visits I had to make (and pay for) because of their mistake.

    I am also sending a letter to the CEO of the company in hopes that the administration can correct this. I am requesting that they send a letter of correction to Cigna since my 2nd appeal is still open. It would be nice to get my case with Cigna approved, but at this point I will take what I can get (even if it's just for the doctor to stop billing me).

    If neither of these letters gets any response, I am going to file a complaint with the state government. I think I have the right department: TN Department of Commerce and Insurance - Consumer Affairs Division (if I am wrong, please tell me). I will probably pay my bill before it gets to this point because I want to be in good standing, and then will let the state decide.

    I will also be paying the bill with a credit card because that puts the credit card company behind me if/when I need to dispute it later. While chargebacks can be used as a means for dishonest consumers to keep from paying their bills, I can assure you that I will be using the process the way that it was intended - and that is to protect innocent consumers.
  3. #3
    OldJimmy is offline Junior Member
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    So, did Cigna have access to those file notes of the doctor's, but then chose to ignore those and relied on a statement by the receptionist to deny your claim? What reason does the doctor give you for refusing to correct the facts with your insurer? I can't imagine any logical reason why they wouldn't do that. Something just seems very odd...

    The disability claim is your biggest target. For three month's pay, I would think it would be worth paying a few bucks for an attorney to write you a nastygram to the facility, citing the discrepancies between the doctor's notes and the receptionist's report being the sole reason your claim is being denied. You need to shake their tree.
  4. #4
    TNUtammy is offline Junior Member
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    Thank you for your reply. I know, this whole situation is odd...and this is only one part of the whole ordeal I have been through. When I asked my doctor about it she said that she has already filled out all the paperwork and can't send in any new information. Everytime I press the issue (which has happened a lot), she just refers me to somebody else who can't/won't help me either.

    The last time I tried to get her to fix something they had me make an appointment with the attending physician, who told me he would get it corrected. However, his way of "correcting it" was just to add on another note saying that his note was to serve as an addendum...but he never actually wrote what he was correcting! Had I known he was doing this I would have said something during the appointment, but unfortunately I wasn't able to view the note until after I went through the medical records request process.

    The only logical reason I can come up with is that this particular facility just likes to come up with ways to get out of doing their work. I guess it's also possible that everyone I've spoken with thus far just doesn't have a clue, doesn't care, or is a certified idiot. They tell you one thing when you are there, then when you get the records back you can see that they only halfway did it. There ought to be a way to enforce that physicians keep their promises to patients, but the world just doesn't seem to work that way. If there is a way to enforce it (that doesn't cost more than it's worth), then I'm just not able to find it.

    As far as my case with Cigna goes, I can't really fight the denied appeals anymore because of all the conflicting information I have in my medical file. If I can't get the doctor to fix it, then I can't get Cigna to approve it (and we all know they have to have everything spelled out for them). I have looked into getting an attorney but all of the firms I have called say that they no longer take short term disability cases. Their reasoning is that they wouldn't be able to recover much more than it would cost to hire them in the first place, which makes sense.

    I know it looks like I am going about this in the wrong order, obviously 3 months of pay is a lot more than 1 doctor visit. There have been a lot of problems on Cigna's end too, but that is a completely different story. Like I said before, I am just going to cut my losses with Cigna. At this point I am just looking to get out of this 3-ring circus without paying the doctor's office for anymore of their crap.

    I have already sent my letters to the billing department and the facility CEO, but it will probably be a while before I know if it accomplished anything. I put my cell phone # on everything I sent them and haven't received a single phone call or another bill, so I guess no news is good news.

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