Medical malpractice - Biiling Cheats

[nics04]

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

Recently I have visited an urgent care medical centre as I had pain in my chest. On the phone they assured me that my insurance company( Aetna) is approved for billing. During registration they told me that I have to pay cash as they are not associated with Aetna. As I was fearing for heart attack I had no option to go anywhere,I had to agree with them. I was billed for 3 different items and I paid( $395)this completely using my credit card. During the process they have taken my insurance details but assured me they will not claim anyhthing from my insurance company as I paid them fully. They gave me a letter of procedure codes in which the above mentioned items were ticked off so that I can claim this with my insurance. Later I sent a claim to my insurance company mentioning the proper procedure codes. My claim was rejected as this hospital does not come in their network. Till now everything is fine.
Few days later I recieved a bill ( by post on 29sep09) from this hospital claiming that I have a due for $275 over unpaid bills for 2 items. Let me expose this cunning, cheating hospital. I have paid them fully before coming out. Then they planned to cheat my insurance company. They sent a claim for 3 items with different procedure codes and different pricing ( differs from the letter they gave me). My insurance company replied them by rejecting the item no.1 and for other 2 items as patient's responsibility. These 2 items amounts $275.
Eventhough I paid them $395 as full amount, they forwarded this bill ($275) to me. I was shocked to see same item description with different procedure codes and pricing. I wonder how a hospital can be shameless to claim the bill twice even after paying it. I came to know about this scam as they mistakenly sent the second bill to me without remebering I had paid them before. When I checked my Insurance online there were 2 claims recorded on the same date. One by me as per correct procedure codes and one by the hospital with manipulated procedure code and pricing. I have every proof regarding this. My question is can I sue this hospital for cheating? Can I claim any compensation?
This hospital is Woodland hills medical clinic,5995 Topanga Cyn blvd
Regards

[ecmst12]

You ALWAYS get (at least) two bills when you go to the emergency room, and for most other procedures done in a hospital or surgery center or radiology center. One bill is from the facility, for the use of the equipment etc. The other is from the doctor that you saw, for his expertise. The codes used will be similar but the bills come from different places. BOTH are entitled to be paid for their services. This is completely normal and not fraudulent or cheating in any way. In fact, if you had any x-rays or other tests done, you will likely get ANOTHER bill for the radiologist reading of the x-rays or the interpretation of whatever other tests you may have had. And this is ALSO normal and expected.

If you were having a medical emergency, you should have gone to the regular ER, then your insurance would have covered the bill (less your ER copay) regardless of network.

[nics04]

Am I confusing in my question? Let me summerise/ correct what I have said before. I have been billed for $395 for all the services provided by the hospital. It was the final billing and I had to pay it before coming out of the medical centre as this hospital is not covered by my insurance.( I am not blaming my insurance, they are fair in that). It was 3 hour visit and evrything was concluded on the same day. They provided the service, they billed it, they got the money. Noway they can claim from my insurance. They promised me they will not claim from my insurance as final billing is paid. After my departure they started processing it to my insurance so that they can be paid again. Here they changed the procedure codes(number) but name of the services are same as they billed it to me. When insurance declined to pay them they forwarded this bill to me without bothering they already recieved money from me. When I asked, they tried to cover up this saying it's a account dept mistake. After this they never dared to ask for the payment again. All the item names which paid earlier appeared in the second bill( they excluded one, so the bill came down to $275). Only difference is procedure code numbers. I have a full list of all services with their procedure codes, this has been given by them. Do you still believe that they can bill me twice and I have to pay it ? Do you think they are right in their approach?

[ecmst12]

If they billed you twice for the same thing and you pointed out the error and they apologized and said you don't owe anything....then the situation is over.

[Zigner]

Originally Posted by nics04

Am I confusing in my question? Let me summerise/ correct what I have said before. I have been billed for $395 for all the services provided by the hospital. It was the final billing and I had to pay it before coming out of the medical centre as this hospital is not covered by my insurance.( I am not blaming my insurance, they are fair in that). It was 3 hour visit and evrything was concluded on the same day. They provided the service, they billed it, they got the money. Noway they can claim from my insurance. They promised me they will not claim from my insurance as final billing is paid. After my departure they started processing it to my insurance so that they can be paid again. Here they changed the procedure codes(number) but name of the services are same as they billed it to me. When insurance declined to pay them they forwarded this bill to me without bothering they already recieved money from me. When I asked, they tried to cover up this saying it's a account dept mistake. After this they never dared to ask for the payment again. All the item names which paid earlier appeared in the second bill( they excluded one, so the bill came down to $275). Only difference is procedure code numbers. I have a full list of all services with their procedure codes, this has been given by them. Do you still believe that they can bill me twice and I have to pay it ? Do you think they are right in their approach?

First - this is NOT malpractice.

And, now you say that you didn't actually have to pay this? You have no case.