PPO Physician balance billing

[latarpley]

What is the name of your state? GA

I am a BCBS PPO cutomer and utilized a PPO facility and a PPO physicain for my addiction recovery. The PPO physician had me sign that I would be responsible for all non covered charges. This was 40 days ago when I was at rock bottom;drunk and drugged. I suffered a seizure two days after entering inpatient. Here is the problem. The physician charges for twice weekly visits and a Coordination of Care for the partial hospital plan that I still attend. The Coordiantion of Care is billed on the same day as one of my visits. BCBS states the Coordination of Care charge is not allowed and the $150.00 is a write of and the providers responsiblity. The physician is requiring that I pay the charges which now total $450.00 for the past three weeks. Unless I pay he is going to sever our relationship which is required for my recovery program. So it is either pay or get kicked out. BCBS states this is a balance billing issue and that the CPC code is covered under my health plan. It is not allowed by the physicians BCBS contract as billed because he is billing on the same day as an appointment. BCBS can take up to 30 days to render a decision and become involved. If I pay I know the money is gone and I will never recover it. This will acknowledge I owe the money and will have to pay $750.00 more for the remainder of my program. If I wait, the doctors actions will remove me from my recovery program. Am I correct this is balance billing and there is a difference between non covered charges and charges they physicain can not charge.
What is my best course of action?.
1. If the doctor immediately terminates our realationship and removes me from my treatment without proper written notice and some sort of time frame is this medical abandonment?
2.There is only one Georgia case law I can find....The patient won in civil court but it was overturned on appeal because they paid the balance billing before suing. Should I get an attorney now or wait for a collection action if he decides to continue our relationship and tries to come after money.
3. The doctor works for a medical group that sees outside patients, but is also part of the hospital medical staff. If an attorney is necessary do I go after the hospital, doctor and his group?

Thank you for any advice on this matter. THIRTY SEVEN DAYS CLEAN AND SOBER.

[ecmst12]

If your doctor is billing you in violation of his contract then that is FRAUD, and you can contact your state insurance commissioner about it.

[averad]

Originally Posted by ecmst12

If your doctor is billing you in violation of his contract then that is FRAUD, and you can contact your state insurance commissioner about it.

If the OP signed a contract with the provider it is not fraud and this happends alot with Medicare or Medicaid members.