doctor billed wrong insurance

[TinkerBelleLuvr]

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

I was covered under a BCBS plan until 6/30/2010. We switched to CIGNA starting 7/1/2010. I received a bill from the doctor I saw on 1/13/2011 that I owe the balance since BCBS denied me coverage.

I provided the doctor a copy of my new insurance card to the office staff when I saw my doctor in September 2010. I paid my co-payment like I'm supposed to and didn't think anything more about it. (Co-pays are identical)

I believe that the office should rebill to Cigna for the September visit and repay BCBS. They think I'm out of my everloving mind since the bill has been paid. I'm afraid that BCBS will come back to ME and expect repayment since I wasn't covered during that time frame.

How much should I insist on this since I have brought it to their attention?

Obviously, the January bill will get covered once they rebill the correct insurance company.

 

[ecmst12]

This is not an issue. Send the bill to your correct insurance company, and call your doctors office to remind them of the change in insurance. Why would BCBS need any money back? They didn't pay anything, correctly, since your coverage was no longer in effect.

Why would you think that the previous visit was billed to the wrong insurance company just because the more recent visit was? You provided your card for THAT visit but not the one in january, which could have been part of the mixup.

 

[TinkerBelleLuvr]

BCBS paid on the September bill when they were NOT technically my insurance. I am sure that they will eventually figure that out and I don't want to get stuck paying BCBS when it should have been CIGNA that paid the bill.

 

[TinkerBelleLuvr]

We changed policies MID YEAR.

 

[ecmst12]

Ok, if you're sure BC paid that bill, call them, tell them about the mistake (they WILL catch it eventually but it might be more difficult to get Cigna to pay if you wait that long), they will take the money back from your doctor and your doctor should rebill to Cigna. BC didn't send the money to YOU though, so they won't be trying to get it back from you.

 

[lealea1005]

I believe that the office should rebill to Cigna for the September visit and repay BCBS. They think I'm out of my everloving mind since the bill has been paid. I'm afraid that BCBS will come back to ME and expect repayment since I wasn't covered during that time frame.

The Doc's office will be out of luck.

BCBS will eventually realize their error (may take more than a year) and take their payment back from the Doc. As already stated, BC did not send the check to you, so you are not responsible for repaying the amount.

Most Cigna contracts require the Doctor to file the claim for their patients, and that must be done within a "timely filing" period. If the claim is not filed within that period, the Doctor cannot (per their contract) bill the patient.

 

[TinkerBelleLuvr]

I have typed a nicely worded letter stating that I want them to rebill CIGNA for both visits and that I will NOT be liable for the amount that BCBS wants back because they figure out that I wasn't covered. I am TELLING them to bill it; I can't cuz I don't have all the billing codes, otherwise, I would take care of it.

I am photocopying my insurance card. Don't know what else I can do with it. I will send it CRRR to protect myself on this one. I figure that I tell you that I'm not covered and who they should be billing that I have done my part. I am still within the reasonable point with billing.

 

[lealea1005]

I have typed a nicely worded letter stating that I want them to rebill CIGNA for both visits and that I will NOT be liable for the amount that BCBS wants back because they figure out that I wasn't covered. I am TELLING them to bill it; I can't cuz I don't have all the billing codes, otherwise, I would take care of it.

I am photocopying my insurance card. Don't know what else I can do with it. I will send it CRRR to protect myself on this one. I figure that I tell you that I'm not covered and who they should be billing that I have done my part. I am still within the reasonable point with billing.

IMHO, your responsibility ended when you gave them your new insurance card at your September visit. They should have photocopied your card at that time, and updated their files/info.

Gosh knows mistakes are made, but I cannot imagine why they will not file the claim with Cigna, get properly paid for their services, and wait for BCBS to correct their error....because it's a well known fact that BC will eventually get their money back.

Good luck with this.

 

[TinkerBelleLuvr]

If you read all the paperwork you sign at a doctor's office, you sign that you will be liable for any amounts NOT covered by the doctor's office. Technically, I could see them sending me to collections if I refused to pay them the amount that BCBS would want back (some time in the future.) I am tellling them that they billed the wrong amount. I figure that I have covered myself at this point by finding the error in a timely fashion and allowing them to rebill it correctly. I would have NO problem going in front of a judge with my letter and CRRR and telling them that I TRIED to get them to fix it.

Hopefully, the doctor's office manager does the right thing and this is NOT an issue. I know they will rebill the January bill. It's the September one that I'm worried about.

 

[mlane58]

If you read all the paperwork you sign at a doctor's office, you sign that you will be liable for any amounts NOT covered by the doctor's office. Technically, I could see them sending me to collections if I refused to pay them the amount that BCBS would want back (some time in the future.) I am tellling them that they billed the wrong amount. I figure that I have covered myself at this point by finding the error in a timely fashion and allowing them to rebill it correctly. I would have NO problem going in front of a judge with my letter and CRRR and telling them that I TRIED to get them to fix it.

Hopefully, the doctor's office manager does the right thing and this is NOT an issue. I know they will rebill the January bill. It's the September one that I'm worried about.

If CIGNA has a contract with your provider than I wouldn't worry abou the doctor coming after you. If that happens, just notify the carrier and let them take care of it.

Also in Florida law, for example, provides that a physician or any representative of a physician, regardless of whether the doctor is under contract with the plan, may not collect or attempt to collect money from, maintain any action at law against or report to a credit agency a subscriber of an organization for payment of services for which the organization is liable, if the physician in good faith knows or should know that the organization is liable.

 

[TinkerBelleLuvr]

I realize that - THAT is why I figure that if I send them the letter giving them ample time to correct their mistake I should be covered. But it's the woulda, shoulda, couldas that get you.

Dealing now with different issue concerning the switchover on insurance companies.

 

[The0racle]

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

I was covered under a BCBS plan until 6/30/2010. We switched to CIGNA starting 7/1/2010. I received a bill from the doctor I saw on 1/13/2011 that I owe the balance since BCBS denied me coverage.

I provided the doctor a copy of my new insurance card to the office staff when I saw my doctor in September 2010. I paid my co-payment like I'm supposed to and didn't think anything more about it. (Co-pays are identical)

I believe that the office should rebill to Cigna for the September visit and repay BCBS. They think I'm out of my everloving mind since the bill has been paid. I'm afraid that BCBS will come back to ME and expect repayment since I wasn't covered during that time frame.

How much should I insist on this since I have brought it to their attention?

Obviously, the January bill will get covered once they rebill the correct insurance company.

You're probably not going to like this answer but I have had something like this happen previously myself.

Generally, the doctor has some fine print that you sign at the time of service that says you agree to their terms.

You will probably need to pay the bill, then dicker with the insurance companies yourself; requesting reimbursement from the appropriate carrier for the services rendered under the time you were covered under either BC/BS or Cigna.

**Another thought: Let BC/BS know that they paid a bill that should have gone to Cigna. Get them to collect from your doctor (they will ask for repayment if they think they over-paid) and then see if your doctor's office is more cooperative about re-billing

Good luck!