• FreeAdvice has a new Terms of Service and Privacy Policy, effective May 25, 2018.
    By continuing to use this site, you are consenting to our Terms of Service and use of cookies.

copay

Accident - Bankruptcy - Criminal Law / DUI - Business - Consumer - Employment - Family - Immigration - Real Estate - Tax - Traffic - Wills   Please click a topic or scroll down for more.

F

fatlobstermac

Guest
What is the name of your state? Tn

I took my son to the doctor and paid the copay, (this was a routine checkup that was covered) a month later, I recieved a bill from the doctor's office for the visit.

I called and they said that my insurance did not pay, I called the insurance, and they said they never recieved the claim.

I relayed this info to the doctor's office and they said they would send it again, well this went back and forth for awhile and the insurance company told me that the doctor's office was not sending the right codes, I relayed this to the doctor's office and they admitted, not really knowing what to send.

Now, Is it my responsibility to pay this, since the doctor's office failed to collect from the insurance company?

This happened about a year ago, we have since changed to a different insurance company.

Thanks to anyone who can help.
 


Beth3

Senior Member
The doctor's office "doesn't know what to send?" Huh? Does that mean they don't know how to properly bill insurance carriers or does it mean they can't figure out how to properly code your claim relative to your diagnosis and services rendered?

You are responsible for payment of the bill(s) since you are the party who incurred the charges, no matter who messed what else up here. Sounds like you need to take a much more assertive role here in ensuring the doctor's office submits this bill properly and soon.
 
F

fatlobstermac

Guest
The doctor's office told me at the time, that they were in some sort of transition stage and the person who was filing their claims was leaving and they were having to get someone to come in and train them on how to file the claims, I know it sounds crazy, but its true. I think they did not know how to do either, claims and codes. I have since changed doctors, because it just seemed like it was always something with them.

Anyway, you answered my question.
 

Beth3

Senior Member
I believe you. But that was a year ago. Hopefully, the doctor has figured out that he'd like to be compensated for his services and has hired someone competent or gotten the staff trained in the interim. Call the doctor's office and tell them that if the doctor wishes to be paid, they MUST submit a bill with the necessary and appropriate information to your former carrier.

If you don't so SOMETHING to get this taken care of, I guarantee you the doctor's office will turn this over to a collection agency and they'll be coming after you soon.
 
F

fatlobstermac

Guest
Is it o.k. for them to resubmit it to the insurance company, that we are not with now? I guess my question is, has to much time not gone by, for them to even worry with the claim?

I was also told, that once you pay your copay, it becomes an issue between the doctor's office and the insurance company.you are not liable for the rest, because the insurance company and the doctor's office have some type of agreement.
Again this is just what someone told me, just wondering if it is true?
 

cbg

I'm a Northern Girl
You submit it to the insurance carrier that you were covered with on the date of service. The carrier you are covered with now has no liability for services that were incurred before your coverage began. Whether they will accept it after this much time depends on their policies and your state law.

You have the bottom line responsibility for any expenses you incur which are not covered by your insurance for whatever reason. The only exception to that would be in situations where the insurance carrier and the provider have a contractual agreement to accept x amount as full payment. In that case, you would have no liability for any difference between x and the full charge other than you copay, and this is probably what you have been hearing about. But any expenses that are just plain not covered by the insurance for a legitimate reason (and yes, not having been submitted in the time frame their policies say and your state law allows is a legitimate reason) are your responsibility, period.
 
F

fatlobstermac

Guest
cbg,

That's the reason I asked the question, was to find out if I were liable, even though the doctor's office screwed up in the filing, I don't think it hurts to find out a little information if you feel unsure about something, and yes the services rendered were covered fully after the copay, I am not trying to not pay them, I just want to make sure it is all legit, now I know, period.

BTW I never expected the insurance company I am with now to pay for this claim.
 

cbg

I'm a Northern Girl
Sorry if I misunderstood you. Also, I think you may have misunderstood me. I'm not yelling at you - sometimes in these posts I use emphasis because it's hard to get the nuances when you're reading an e-mail post. If you and I were talking together you'd be able to hear where I mean the emphasis to be but you won't necessarily get it in a written communication unless I put it there. It doesn't mean I'm annoyed with you or that I think you're wrong for asking the question or that I'm trying to come down hard on you - I'm just trying to put the missing nuances in, and sometimes it doesn't come out like I intend. Sorry if you thought I was doing anything but just trying to answer your question as best I could.

And as I hit the submit button I realized that THAT might have come out wrong too. Honestly, I understand why you asked the question and there's nothing wrong with it and I'm just trying to help and not coming out the way I intend, okay? :)
 
F

fatlobstermac

Guest
I did misunderstand you, but now I see the way it was all intended.

Again, thanks for the advice, I am just clueless when it comes to these things, I have always recieved good advice on this site.
 

lkc15507

Member
Well, I want to add this. Your first insurer / carrier has received the claim. After all the back-and-forth, a large amount of time has passed. Which, if I understand correctly is the basis of denial of the claim now--timely filing. Have the claim submitted to the carrier under which you were covered at the time of service. In my opinion, the claim is / was received timely--even if codes were not correct. ie, as cbg says, submit the claim to the carrier covering you at the time. They received it timely. They need process and likely pay it.

lkc15507
 

Find the Right Lawyer for Your Legal Issue!

Fast, Free, and Confidential
data-ad-format="auto">
Top