What is the name of your state (only U.S. law)? Pennsylvania
We have a Blue Cross/Blue Shield PPO, w/ a $1000 deductible per individual (for non-covered expenses, etc). We live in PA, the PPO is based out of Texas (my husband's company's headquarters).
I got 3 stitches in my finger at the ER (because our doctor's office was closed over Mem. Day weekend). I paid the $75 ER copay, as well as the $92 deductible to the Hospital/ER that was left over from what our health insurance did not cover.
Now, I am receiving an additional bill from a physician's group, supposedly from the physician (actually, physician's assistant) that treated me. The PPO is denying this bill/claim altogether, leaving me with an almost $200 bill. I have several questions regarding this bill and the legalities:
1. Can they double-bill me (the physician's group) for services already paid through the ER and my copay. They are charging me for an ER visit ($82) and repairing the wound ($101.96). Is this allowed, since I already paid for this through the hospital?
2. The physician's group is charging me a $16 fee for monitering my "blood oxygen level". At NO time did any doctor take blood or check my pulse. The nurse did check my temperature/blood pressure when I was being admitted w/ an ear thermometer. Why the $16 charge from the physician's group?
3. Why does my insurance not have to cover the doctor's services? When I normally go to any doctor that is a PPO member, I am only responsible for the copay.
I talked to the non-helpful insurance company today. They basically said I was responsible for the bill, and tried to tell me the nurse checking my temperature w/ an ear thermometer was worth the $16 charge. I was supposed to participate in a customer survey afterwards, and somehow the lady who was on the phone with me put me on hold and made it so I could not access the survery (after she stopped talking to me).
When I had 100% coverage (no deductible) in the past through Blue Cross, the same thing happened one time. Blue Cross then told me that it was not legal for the doctor to "double bill" me and THEY refused to pay the bill. I feel as if they don't care because I have a deductible.
Any help would be appreciated. It's not about the money, it's about what is right or wrong. It's about the insurance company's rudeness and poor customer service.
Thank you!What is the name of your state (only U.S. law)?