Can a doctor refuse to reimburse when he is under insurance contract

[msmargiek]

What is the name of your state (only U.S. law)?

 

[OHRoadwarrior]

If a doctor is in network and your insurance pays him under contract, refer to your insurance companies EOB for the visit. It outlines the contractual amounts the doctor agreed to accept, the portion they are paying under your contract and the portion you are responsible for. Some providers attempt to "balance bill" "accidentally". In fact I just received a $3k "accident". Call them and remind them of what the EOB outlines, they should adjust it. If they do not call your insurance company and ask them to intervene.

 

[msmargiek]

Thank you for your response

I have done all of that and the doctor still says he is not under that contract any longer. He said he is not under that EOB. He said he cancelled it but later recounted that his front desk help ;maybe" didn't follow through with all the paperwork to finish the cancelling of his contract. He will not adjust the bill and the insurance company said they can't help because the reduced amount is all they will pay and they are just taking the reduced amount off my deductible so they are not paying him directly. I paid him cash.

 

[OHRoadwarrior]

If the insurance EOB says no balance amount is due and the amount is enough. I would take it to small claims.

 

[ecmst12]

He shouldn't have even taken money from you up front if he was in network. You should ask the provider relations department at your insurance company to get involved, what he is doing is fraud and they should be encouraging him not to break the law.