Doctor charging more than PPO agreed amount

[atoz123]

What is the name of your state? WA

A couple of years back, I had gone to an in-network PPO doctor The insurance company reduced the billed charges ($1000) by about 50 % for Negotiated Network Charge and paid 80% ($400) and stated the patient responsibility as 20% of the reduced amount of $500 which came to $100. The doctor however sent me a bill for the 20% + the difference due to the network negotiated charge reduction taken by the insurance (Bill for $600). I sent a letter to the doctor attaching the Explanation of Benefits from the insurance. The doctor did not reply, but sent my account to a collection agency.
I immediately responded to the collection agency with the documents. There was no response, so I followed up with the collection agency who said the doctor will call as all documents have been sent to them. Still no response. After a year, I get another bill from the doctor for the same amount $600 , but added a big interest of $500 in addition. I again contacted the doctor who asked me to submit whatever documents I got to support my claim that I owe only $100. I sent it, but after a few months, now I have got another letter from a different collection agency, which has added another interest of $400 (stating that it was 12% as per RCW 19.52.010) for a total of $1500.

1. Can an in-network PPO doctor charge more than the network negotiated charge as stated by the insurance?
2. Can they arbitrarily tag on interest rates? The doctor added $500 and the collection agency another $400?
3. I am and always was ready to pay the $100 that the insurance said was my responsibility. In each of my correspondence (Certified Mail with return receipt) to the doctor and collection agency, I have pointed that I would like to pay that and they should send a revised bill. However the doctor does not mention anything about that, but keeps sending bill for the higher amount. How should I respond to the collection agency now?

Thank you very much...

[somarco]

Barring something unusual in the contract with the PPO network, the answer is no, the doc cannot balance bill for the difference. Providers sign contracts with PPO networks and agree to accept as "payment in full" the negotiated rate for services provided. The PPO networks rent their contractual arrangement to carriers who apply those discounts to their claim adjudication.

What has your carrier had to say about this? They are the ones who should be involved in dealing with the provider, not you.

[cbg]

You need to:

1.) Pay the $100 that is not in dispute immediately - do not wait for an amended bill.

2.) Contact the Provider Relations department of your insurance carrier.

3.) Tell them that you are being "balanced billed" by your provider.

4.) Follow whatever instructions they give you to the letter (which will probably, but not definitely, be to let them handle it).

5.) Be certain that they know that the disputed amount is already in collections.

[Buckley]

He charged you $500 interest on a $600 bill? Seems like he sort of violated the state of Washington's Usury laws which mandate a maximum of 12 percent interest where no previous interest agreement existed. I would report him to the state.

[ablessin]

The carrier provider lines probably will not help OP.
She needs to call regular member services and explain this all to them.
Member services will, no doubt, contact provider services.

Provider services is for providers. Not members and vice versa.

They can not balance bill you if they are participating providers.
Immediately send $100 since your carrier said you owe it. By not paying it, you are not upholding your piece of the deal.

Let them worry about the rest.
Insist that this is cleared from your credit report immediately. And ask for a letter from collections agency stating it was on your credit report in error to begin with.
I work in a hospital collections office, so I know for a fact that this can be done, as things do get reported to patient credit report in error sometimes.

Then, find a new doc.