Doctor refuses to provide insurance with Itemized bill, for payment.

[Flight50]

Hawaii; Doctors office is under agreement that states insurance will pay 100% of billed charges. Doctor refuses to bill insurance or send itemized bill for insurance to process the claim. Because of a previous bill that was sent directly to me which I had no knowledge of by insurer, check was reissued and paid in full to the doctors office for previous visits. (2 months Late) I filed the new claim with insurance through email and two faxed since doctor would not Bill the insurance. I have records of these attempts to send bills but, insurance mishandled the first two attempts. Finally I involved my work HR department who gave me a direct person to contact with the insurance. This particular lady called multiple time to the doctors office with no luck. They would not give her an itemized bill so, she was unable to pay the claim. Now, the claim has gone to collection and affected my credit. I wrote a letter to the doctor requesting a resolve and they then sent an itemized bill to the insurance, which agreed to pay month ago. They would not deal with my issue related to the credit report. I have showed good faith with many calls and emails to all parties involved, but doctors office seems to be coming after me. I have paid all copays and portions owed by me and remaining bill under contract is insurance responsiblity. Is their any legal action against the doctor I can take for hurting my credit? I noticed in another tread a legal expert stated the doctor could get in trouble for not allowing the insurance to pay their portion of the bill? Would anyone elaborate on this?

 

[seniorjudge]

Q: Is their any legal action against the doctor I can take for hurting my credit? I noticed in another tread a legal expert stated the doctor could get in trouble for not allowing the insurance to pay their portion of the bill? Would anyone elaborate on this?

A: The doctor did not hurt your credit; you did it by not paying the bill. Pay the bill and then you and the insurance company fight it out.

 

[lealea1005]

I wrote a letter to the doctor requesting a resolve and they then sent an itemized bill to the insurance, which agreed to pay month ago.

They already sent in a claim. It costs money to generate/send in claims. Your insurance company seems to continually "lose" or mishandle their claims.

I have showed good faith with many calls and emails to all parties involved, but doctors office seems to be coming after me. I have paid all copays and portions owed by me and remaining bill under contract is insurance responsiblity.

YOUR responsibility is to pay the Physician. Paying the Physician, then working with your insurance company, especially after all the previous issues, would have been "good faith".

Is their any legal action against the doctor I can take for hurting my credit? I noticed in another tread a legal expert stated the doctor could get in trouble for not allowing the insurance to pay their portion of the bill? Would anyone elaborate on this?

If your Physician is contracted with your insurance company s/he may be required to accept their "reasonable & customary" fees as payment in full. That doesn't necessarily mean the check will go directly to the Physician. Ultimately, it is YOUR repsonsibility to make sure your Physician is paid for the services s/he renders to you.

 

[ecmst12]

If the doctor is contracted with the insurance company, and has not submitted the bill even once to them, then he is probably in violation of his contract. The contract likely also forbids him from billing you prior to getting an EOB from your insurance. But if you want to resolve the problem quickly, you need to go into the office IN PERSON and insist that they hand you the itemized bills on the proper HCFA forms so you can submit them to your insurance company. Then do so.

Then, find a new doctor that is willing to comply with the terms of his contract and not put the patient in the middle of his issues with the insurance company.

 

[Flight50]

If I was to hire an attorney, would s/he be abler to reverse the actions taken against my credit. Which luckily was very high and had a small affect, never missed a payment.

Is the doctors office required to bill the insurance? in this situation they NEVER billed insurance until they took action against me then sent an itemized bill to insurance for payment. They would not bill even at my request or the insurance company's before the bill went to colllection.

 

[Flight50]

Bill has been resolve and paid in full after it was sent to colllection. The office sent insurance an itemized bill and insurance paid the claim in full. The office refused to sent anything to Insurance before it went to collection. Insurance and myself contacted doctors office many times before it was sent to collection. Each time Doctor refused to bill or send requested information to insurance for payment. Insurance was ready to pay the claim.

 

[lealea1005]

If I was to hire an attorney, would s/he be abler to reverse the actions taken against my credit. Which luckily was very high and had a small affect, never missed a payment.

Is the doctors office required to bill the insurance? in this situation they NEVER billed insurance until they took action against me then sent an itemized bill to insurance for payment. They would not bill even at my request or the insurance company's before the bill went to colllection.

Do you know whether your Physician is even contracted with your insurance company? Just because he agrees to accept what they will pay, doesn't necessarily mean he's has a contract with them.

 

[Flight50]

The doctor was given from the insurance a letter stating to bill on behalf of cleint and recieve payment of 100% of billed services. This letter was also, walked in by me and agreed upon by the Doctor. The office had billed previously and recieved 100% payment for services under this letter.

 

[ecmst12]

If the doctor does NOT have an actual contract with your insurance company, then he is not REQUIRED to bill them for you. In the future, if you want to continue seeing this doctor, you should pay the bill yourself and submit the claim to your insurance compnay for reimbursement yourself.

 

[Flight50]

That was the problem, the office would not give the required information for me to bill the insurance and stated they would not send a bill until I paid. I spoke to the insurance and they stated I would not get reembursed if they did not recieve a bill of services. I was unaware I could request an itemized bill until it was to late. It should be buyer beware even thought it seems not to be. The doctors deal with these issues all the time not the client they should know and provide the information. I beleive it did not mater what I did the doctors office would of never sent the bill. We did have a verbal agreement backed up with a written letter to all parties, which they had followed and been paid under for previous bills. I just want to find out what the best course of action maybe to correct actions taken against my credit.