Illegal Billing?

[moburkes]

Thank you for all your replies. I will take up this matter with Medicaid and the New York State Insurance Department.

Medicaid is your best bet. I have NO IDEA what contacting the State will do. What will you say when they asked if you signed a form that gives you responsibility for the treatments/visits/procedures that you received?

 

[lealea1005]

Accepting your copay means nothing. Your copay is printed on your card, that's all they were going by. Verifying with the insurance company just means that they verified you were covered, not that they participate. Payment is never guaranteed until the bill is received and processed by the insurance company.

But it is not your fault that customer service has not been helping you, I will give you that. You have been trying to do everything right. UHC works for the Medicaid office in this case, so (again) that is why I suggested appealing to their bosses. The department of insurance may also be able to help. I don't understand what kind of insurance plan, even a Medicaid one, can't even tell you whether a doctor participates when you call. That's like, the most basic of basic information you can ask for.

I agree with you but there have been more than a couple of times a UHC Medicaid recipient has called our office for an appointment because a UHC rep informed them that we are participating providers. We are participating providers for UHC with the exception of their Medical Assistance product. So, I do think the patient has to be more specific when asking the office staff or insurance rep. which Doctors participate.

 

[badadjective]

Exactly ecmst12!! UHC has almost made it an official policy not to tell me. I'd love to be able to just call and ask if a specific doctor participates. I was left with the choice of either letting my health deteriorate quickly or seeing a doctor that told me he participates in my insurance. Even if I lose in the battle, I don't have a penny to give them. I have Medicaid for a reason, and that reason is because I have no money. I'm concerned about my credit history, which at this point is excellent and is one of the factors that is helping get back on my feet after college. If I have to go to court and lose, my credit history will be destroyed but I still won't be able to pay them! Is this a lose/lose situation or what?

 

[ecmst12]

But when someone calls their insurance customer service department, the number on their card, they are supposed to be directed to someone at UHC who deals specifically (and possibly ONLY) with their plan. If that's what OP did, and the CSR at UHC couldn't tell him what doctors participate, that's a pretty big problem if you ask me. I don't expect a doctors office to know (necessarily) which plans they do or don't participate with. I DO expect the insurance company to know which doctors are contracted for which plans! And with a plan the size of NY state medicaid, I would expect them to have a department within UHC which ONLY handles that plan and no other. There's just no excuse for that. I can't put 100% of the blame on OP here (even though he's still legally responsible for the bill), he did put forth a more than reasonable effort (by calling UHC) to make sure he was going to the right doctors.

 

[lealea1005]

Exactly ecmst12!! UHC has almost made it an official policy not to tell me. I'd love to be able to just call and ask if a specific doctor participates. I was left with the choice of either letting my health deteriorate quickly or seeing a doctor that told me he participates in my insurance. Even if I lose in the battle, I don't have a penny to give them. I have Medicaid for a reason, and that reason is because I have no money. I'm concerned about my credit history, which at this point is excellent and is one of the factors that is helping get back on my feet after college. If I have to go to court and lose, my credit history will be destroyed but I still won't be able to pay them! Is this a lose/lose situation or what?

You've graduated from college. Are you now working?

 

[lealea1005]

But when someone calls their insurance customer service department, the number on their card, they are supposed to be directed to someone at UHC who deals specifically (and possibly ONLY) with their plan. If that's what OP did, and the CSR at UHC couldn't tell him what doctors participate, that's a pretty big problem if you ask me. I don't expect a doctors office to know (necessarily) which plans they do or don't participate with. I DO expect the insurance company to know which doctors are contracted for which plans! And with a plan the size of NY state medicaid, I would expect them to have a department within UHC which ONLY handles that plan and no other. There's just no excuse for that. I can't put 100% of the blame on OP here (even though he's still legally responsible for the bill), he did put forth a more than reasonable effort (by calling UHC) to make sure he was going to the right doctors.

I totally agree with you. OP, did you happen to document the dates of your inquiries and the name(s) of the representatives you spoke with?

 

[badadjective]

lealea, that is what I'm saying. I had no way of knowing for sure no matter who I spoke with. When I asked the potential doctor/lab they said they participate. When I call (or they call I guess) UHC either doesn't respond to me or doesn't give the doctor the correct information. So why am I responsible?
As far as the form I signed, that doesn't remove their responsibility if there was negligence. If you sign a contract saying you allow me to kill you with knife that does not make it legally allowable. I understand there is a difference between logic and law. What is logical is rarely the law, but if I am specifically told by a doctor that they participate in my insurance and I have no other form of verifying that information, why should I be held liable?

 

[moburkes]

You've graduated from college. Are you now working?

Exactly. S/he is broke today, but won't be broke forever.


ecmst-What you are asking for is impossible. If there are hundreds of insurance plans, UHC is not hiring 100 different departments of say 10 or 12 people so that they are staffed properly. Each rep will be able to answer the question for several plans, because, on their computer screen, once you pull up the member number, the information is listed. ALSO, OP received a plan booklet, and with it came a list of participating doctors. You all should know by now, that my daughter is on Medicaid. She received a copy of her policy, and a list of participating doctors/facilities. If you lost it, you ask for another. Every health insurance company that writes a policy is required to give a list of participating doctors.

 

[moburkes]

lealea, that is what I'm saying. I had no way of knowing for sure no matter who I spoke with. When I asked the potential doctor/lab they said they participate. When I call (or they call I guess) UHC either doesn't respond to me or doesn't give the doctor the correct information. So why am I responsible?
As far as the form I signed, that doesn't remove their responsibility if there was negligence. If you sign a contract saying you allow me to kill you with knife that does not make it legally allowable. I understand there is a difference between logic and law. What is logical is rarely the law, but if I am specifically told by a doctor that they participate in my insurance and I have no other form of verifying that information, why should I be held liable?

A contract about killing someone's wife is an illegal contract. The contract that states that you are responsible for paying for the services that you receive is not in any way an illegal contract. So, don't compare the 2. You need to make up your mind if YOU called your provider or if the DOCTOR's office called them. In either case, you are responsible for the treatment that you received. What they did does not meet the legal definition of negligence.

You are held liable for this basic reason: They treated you, and they don't do it for free. They don't care who pays them, as long as they are paid. What doctor's office wouldn't like to receive a quick, timely payment from an insurance company? Your thought process means that they'd rather wait until you have a check to garnish before they get paid.

And, you don't have the right, unfortunately, to receive medical care. Only in specific situations do you have that right.

 

[lealea1005]

lealea, that is what I'm saying. I had no way of knowing for sure no matter who I spoke with. When I asked the potential doctor/lab they said they participate. When I call (or they call I guess) UHC either doesn't respond to me or doesn't give the doctor the correct information. So why am I responsible?
As far as the form I signed, that doesn't remove their responsibility if there was negligence. If you sign a contract saying you allow me to kill you with knife that does not make it legally allowable. I understand there is a difference between logic and law. What is logical is rarely the law, but if I am specifically told by a doctor that they participate in my insurance and I have no other form of verifying that information, why should I be held liable?

Which is why we providers require the patient to sign the form. Again, from what you're saying, that means every Doctor/lab you received a service from, knowlingly told you they were participating providers when they were not. Hard to believe.

 

[badadjective]

yes, I currently work. I make enough to survive. These recent health problems have made it even more difficult for me to work, that is why I've been going to so many doctors so quickly. This was all coordinated through my primary care, with referrals, and even she called the doctors she referred me to in order to check if they participate in my insurance.

 

[lealea1005]

OP, if you do not at least attempt to contact the Doctors/lab, explain the situation and try to set up some sort of payment plan, they WILL take you to court and they will win. Any future cars/homes/loans will be held up until the judgement is satisfied. If you speak to them first, they MAY be a little empathetic and agree to a lower fee OR set up a reasonable payment schedule.

 

[badadjective]

Yes, I know it is hard to believe lealea. But that is what happened. Whether they intentionally lied, or were just careless in finding out for sure, or if UHC didn't give them the correct information, I don't know. Maybe the doctors had nothing to do with it and in fact UHC mistakenly verified them as participating providers? That would explain why it happened across so many doctors, if UHC does not provide information correctly to providers. If they can't provide it to me, why would they provide it to doctors/labs?

 

[badadjective]

lealea, one doctor has reduced a bill from $1100 to $375 which as I explained to them was very generous. However, they provided services under false pretenses (as I believe). Whether it was their fault or UHC I don't know. What I do know is that I don't have $375. The person in charge of billing promptly hung up the phone on me despite the fact that I was being very polite and calm throughout the entire conversation.

 

[lealea1005]

yes, I currently work. I make enough to survive. These recent health problems have made it even more difficult for me to work, that is why I've been going to so many doctors so quickly. This was all coordinated through my primary care, with referrals, and even she called the doctors she referred me to in order to check if they participate in my insurance.

To be honest, half the time the actual Physician couldn't tell you which insurance plans they currently participate with. Contracts change all the time.