My HC provider is billing me 4 the cost of billing the Ins Co.

[Blue Colnago]

My Health care provider is billing me a small charge, $5.00 everytime they bill and re-bill my PPO Insurance company. Seems to me this is ought to be just part of the cost of doing buisness as usual. If my insurance company is not responding to the bills in a timely manner or not paying what they owe, why is this my problem?

I've paid everything I've been asked to pay over 6 months ago, (for the procedures I received) my side of the street is clean. Yet there is still something unsettled between my provider and my PPO.

Is it legal for my provider to bill ME for the cost of billing the Insurance company?

Thanks in advance,
I live in Illinois.

 

[justalayman]

Call your insruance company. They have a contract with the health care provider that would control what you can and cannot be billed as long as they are "in network" providers.

 

[lealea1005]

Hi. Each time a Claim is filed it costs your Doctor about $5.00. Understand that the "negotiated" payment by the insurance company for a service you receive is a fraction of the Doctor's usual fee. It becomes frustrating when we know the insurance company has all the information they need, yet they tell us the claim is "lost" or the coding is incorrect or some other excuse to hold payment. We are told to re-submit the claim when they can just as easily process it because they already have the information they need! The office may be passing that cost over to you. They cannot collect the $5.00 fee because, as justalayman says, they are under contract with your insurance company.

Call your Doctor's office and ask to speak with the office manager about the charges, he/she may explain their reason for passing the fee to you (usually they're more than eager). Then call the insurance company and ask why the Doctor hasn't been paid.

Hope this explanation helps...have a good day.

 

[Blue Colnago]

..

Justalayman - The contractual obligations were the key element I was not understanding, this aided me greatly in dealing with my issue, thank you.

lealea1005 - Hearing how things live on the other side of the fence has helped my frustration level. I was therefore able to have a very graceful conversation with my provider. The direct outcome of this conversation was they agreed to remove all my charges, and resolve the issue with my insurance company directly. I needed to be knowledgable, patient and tactful in order to produce this result. Your post helped me get the proper frame of mind to put my personal frustation aside, and achieve a graceful, effortless resolve. Thank you.

-Jack B.
Chicago Ill.

 

[lealea1005]

You are more than welcome!

 

[justalayman]

You are more than welcome!

ditto