What is the name of your state (only U.S. law)? California
I have a hot mess of a situation. My doctor's office wrongly collected a deductible for services covered under an office visit copayment. They collected $297.70 which was a $30 copay from a previous visit plus $267.70 which was what they said I owed for my deductible. When I realized my insurance covered everything but a $30 copayment and issued payment to my doctor's office I called the billing department asking when I would be issued a refund. I had to call several times and leave messages with no return call. Finally I got the billing girl on the phone who said she would try to expedite the situation and to call back in a week if I hadn't heard anything, so I said okay and that in the meantime I had received a statement from them for a $30 copay and if she could pay for that out of the refund. The following week I get a check for $107.70, which is $100 less than what it should have been. After numerous voicemails and finally going through the front office staff and demanding to speak with someone the biller gets on the phone and tells me that their system checks for no show fees before it issues refunds. I'm astounded.... I have zero no shows since becoming a patient there. I ask to speak to the office manager and am told that if I do that she will probably tack on more. At that point I realized I wasn't getting anywhere and being threatened and I politely ended the call.
Since then:
I have found out from my insurance that my benefits clearly state any procedures done while in an office setting and being charged in addition to an office visit charge do not apply to a deductible. Basically the only things that apply to my deductible are outpatient surgeries where an office visit is not charged, labs and diagnostics, hospital and er charges. Anything done in an office visit doesn't apply to the deductible and it clearly states that, so the doctors office should have known. The claims department told me to contact fraud and ethics department to see if there was anything they could do. Fraud and Ethics said that it violates their contract with the doctor if they knowingly collected money they knew I wouldn't owe in order to withhold it from me later. So a fraud case was opened through my health insurance. Still pending.
I tried to dispute $100 of the original charge through card services for my flex spending card I used to pay for my deductible. The reason I used for the dispute is that flex spending dollars were used to pay for no show fees instead of the deductible I was told I was being charged for. They denied the dispute because they can't issue a chargeback because I gave the provider my card and signed for it.... even though I didn't authorize it for no show fees....
I have since tried to get any documentation I can from them stating the funds were specifically applied to no show fees, and also documentation of when these supposed no show fees occurred so I could dispute them. I was told that only the office manager could print out a complete list of my appointments but she was unavailable, after I was already told it would be no problem and a copy would be waiting with my medical records when I came to pick them up. So I had the front office staff read off every appointment so I could write them all down and got the receptionist name and dated it so I have a record in case anything else comes up.
I received a new bill for $100 even though they still owe me $100. When I went in person and spoke to the biller she gave me a print out that showed two new no show fees had been added to my account both dated for the same day in january when I was seen in the office. She said that the office manager had added them onto my account because I had done a chargeback for $100 on my flex spending card. I told her that yes I had disputed the charge, but that my dispute was denied and that no chargeback was ever issued. They haven't shown me any proof that a chargeback was issued, but state that it was. I however contacted both my flex spending account and the cardholder services and both confirmed that no chargeback was ever done to the doctors office.
What can I do legally? Should I file a complaint with the medical board? BBB? Can I take them to small claims court and how do I go about it? They are doing so many different things wrong.
Doctor's office collecting money they know I won't owe.
Flex Spending dollars applied to something I didn't authorize.
No show fees that I know I don't have, but I only have phone records for one of the original two I was charged for.
Edit:
Also, is it legal for a doctor's office to only charge people due refunds (basically patients they have collected a deductible from that they then need to refund) for no show fees? Then not charging no shows to patients who are covered 100% by insurance or who only have an office visit copayment and aren't due refunds?
I have a hot mess of a situation. My doctor's office wrongly collected a deductible for services covered under an office visit copayment. They collected $297.70 which was a $30 copay from a previous visit plus $267.70 which was what they said I owed for my deductible. When I realized my insurance covered everything but a $30 copayment and issued payment to my doctor's office I called the billing department asking when I would be issued a refund. I had to call several times and leave messages with no return call. Finally I got the billing girl on the phone who said she would try to expedite the situation and to call back in a week if I hadn't heard anything, so I said okay and that in the meantime I had received a statement from them for a $30 copay and if she could pay for that out of the refund. The following week I get a check for $107.70, which is $100 less than what it should have been. After numerous voicemails and finally going through the front office staff and demanding to speak with someone the biller gets on the phone and tells me that their system checks for no show fees before it issues refunds. I'm astounded.... I have zero no shows since becoming a patient there. I ask to speak to the office manager and am told that if I do that she will probably tack on more. At that point I realized I wasn't getting anywhere and being threatened and I politely ended the call.
Since then:
I have found out from my insurance that my benefits clearly state any procedures done while in an office setting and being charged in addition to an office visit charge do not apply to a deductible. Basically the only things that apply to my deductible are outpatient surgeries where an office visit is not charged, labs and diagnostics, hospital and er charges. Anything done in an office visit doesn't apply to the deductible and it clearly states that, so the doctors office should have known. The claims department told me to contact fraud and ethics department to see if there was anything they could do. Fraud and Ethics said that it violates their contract with the doctor if they knowingly collected money they knew I wouldn't owe in order to withhold it from me later. So a fraud case was opened through my health insurance. Still pending.
I tried to dispute $100 of the original charge through card services for my flex spending card I used to pay for my deductible. The reason I used for the dispute is that flex spending dollars were used to pay for no show fees instead of the deductible I was told I was being charged for. They denied the dispute because they can't issue a chargeback because I gave the provider my card and signed for it.... even though I didn't authorize it for no show fees....
I have since tried to get any documentation I can from them stating the funds were specifically applied to no show fees, and also documentation of when these supposed no show fees occurred so I could dispute them. I was told that only the office manager could print out a complete list of my appointments but she was unavailable, after I was already told it would be no problem and a copy would be waiting with my medical records when I came to pick them up. So I had the front office staff read off every appointment so I could write them all down and got the receptionist name and dated it so I have a record in case anything else comes up.
I received a new bill for $100 even though they still owe me $100. When I went in person and spoke to the biller she gave me a print out that showed two new no show fees had been added to my account both dated for the same day in january when I was seen in the office. She said that the office manager had added them onto my account because I had done a chargeback for $100 on my flex spending card. I told her that yes I had disputed the charge, but that my dispute was denied and that no chargeback was ever issued. They haven't shown me any proof that a chargeback was issued, but state that it was. I however contacted both my flex spending account and the cardholder services and both confirmed that no chargeback was ever done to the doctors office.
What can I do legally? Should I file a complaint with the medical board? BBB? Can I take them to small claims court and how do I go about it? They are doing so many different things wrong.
Doctor's office collecting money they know I won't owe.
Flex Spending dollars applied to something I didn't authorize.
No show fees that I know I don't have, but I only have phone records for one of the original two I was charged for.
Edit:
Also, is it legal for a doctor's office to only charge people due refunds (basically patients they have collected a deductible from that they then need to refund) for no show fees? Then not charging no shows to patients who are covered 100% by insurance or who only have an office visit copayment and aren't due refunds?
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