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Optometrist Billing For Services not Rendered 8 Months after service

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danielterrones

Junior Member
I'm posting this on behalf of my wife. We live in California. On November of 2011 my wife went to the optometrist for an eye exam because she needed contacts. November of 2011, she went to her appointment and received a full exam (Glasses Prescription + Contact Fitting), additionally we purchased 2 boxes of contacts that day. All of this was payed for by our insurance without any questions or confusion.

Fast forward to April of 2012 - my wife ran out of contacts and she wanted to buy glasses. She called in to schedule an appointment for Glasses Prescription (my wife was unaware that she ever received a glasses prescription exam - she thought she only received contact fitting in Nov 2011). When she arrived to the Dr. office, she checked in with the receptionist, and the receptionist told my wife, "You do not need an eye exam to buy glasses, we already provided that service in November of 2011." My wife was very confused and continued to tell the receptionist that he must be confused because she thought she never received a glasses prescription/exam (she thought she only received a contact fitting). My wife continued to fight with the receptionist in the lobby until I intervened. I understood what the receptionist was saying, I explained to my wife that whether she knew it or not she received a glasses prescription/exam in November of 2011. After we were all on the same page and everyone understood everything - my wife and I purchased 2 more boxes of contacts (we payed cash because our insurance only covers 2 boxes per 12 months), and we browsed at glasses but didn't pick anything out. NOTE: The receipt we received on April of 2012 ONLY SHOWS the 2 boxes of contacts, no services.

Fast forward to Yesterday 12/19/12. I contacted the optometrist office to schedule an appointment for my wife to get new contacts and an updated exam if it was needed. They proceeded to tell me that we had a balance with their office of $200. I asked for a detailed explanation of what the charges were for. They told me that it was for the exam that my wife received in April of 2012. I told them that my wife didn't have an exam in April, she originally went in for an exam but we were informed back in April that an exam wasn't necessary. He asked me to schedule an appt. with billing department. I went and visited them in person yesterday. The billing dept. said that the doctor had exam notes from April of 2012 and that he wouldn't put notes in there unless there was a reason to. The notes were very very vague and said something to the extent of, "Katelyn came in because she said that her contacts hurt". Additionally, i asked him to RE-print the receipt from April of 2012 and he did - this new receipt showed a line item, "EYE EXAM + CONTACT FITTING$200.00".

So what do I do in this case? I would like to believe that their billing department made a simple mistake but I'm starting to believe that they are cheating the system in order to get more money from insurance companies/customers. They are billing us for services that we 100% know that my wife did not receive. Please help!!!
 


OHRoadwarrior

Senior Member
You are in a gray area, because you scheduled and arrived for an appointment. I would contact your insurance and request their guidance and intervention according to their contract with the provider.
 

barry1817

Senior Member
seems to be billing fraud

I'm posting this on behalf of my wife. We live in California. On November of 2011 my wife went to the optometrist for an eye exam because she needed contacts. November of 2011, she went to her appointment and received a full exam (Glasses Prescription + Contact Fitting), additionally we purchased 2 boxes of contacts that day. All of this was payed for by our insurance without any questions or confusion.

Fast forward to April of 2012 - my wife ran out of contacts and she wanted to buy glasses. She called in to schedule an appointment for Glasses Prescription (my wife was unaware that she ever received a glasses prescription exam - she thought she only received contact fitting in Nov 2011). When she arrived to the Dr. office, she checked in with the receptionist, and the receptionist told my wife, "You do not need an eye exam to buy glasses, we already provided that service in November of 2011." My wife was very confused and continued to tell the receptionist that he must be confused because she thought she never received a glasses prescription/exam (she thought she only received a contact fitting). My wife continued to fight with the receptionist in the lobby until I intervened. I understood what the receptionist was saying, I explained to my wife that whether she knew it or not she received a glasses prescription/exam in November of 2011. After we were all on the same page and everyone understood everything - my wife and I purchased 2 more boxes of contacts (we payed cash because our insurance only covers 2 boxes per 12 months), and we browsed at glasses but didn't pick anything out. NOTE: The receipt we received on April of 2012 ONLY SHOWS the 2 boxes of contacts, no services.

Fast forward to Yesterday 12/19/12. I contacted the optometrist office to schedule an appointment for my wife to get new contacts and an updated exam if it was needed. They proceeded to tell me that we had a balance with their office of $200. I asked for a detailed explanation of what the charges were for. They told me that it was for the exam that my wife received in April of 2012. I told them that my wife didn't have an exam in April, she originally went in for an exam but we were informed back in April that an exam wasn't necessary. He asked me to schedule an appt. with billing department. I went and visited them in person yesterday. The billing dept. said that the doctor had exam notes from April of 2012 and that he wouldn't put notes in there unless there was a reason to. The notes were very very vague and said something to the extent of, "Katelyn came in because she said that her contacts hurt". Additionally, i asked him to RE-print the receipt from April of 2012 and he did - this new receipt showed a line item, "EYE EXAM + CONTACT FITTING$200.00".

So what do I do in this case? I would like to believe that their billing department made a simple mistake but I'm starting to believe that they are cheating the system in order to get more money from insurance companies/customers. They are billing us for services that we 100% know that my wife did not receive. Please help!!!
I would say that this is wrong, that the billing is in error, and that they have the proper time to correct it.

If not corrected, you would consider this bill to be a fraudulent billing situation and explain that you will put the bill and your explanation to your state licensing board and see what they have to say.

State boards take billing fraud seriously, and from what you have said, the notes in the charts are an attempt to promote a fraud as they are not accurate.
 

Nancy Lopez

Junior Member
You have been billed wrongly and I can say it is a case of fraud. You can go to the attorney and take legal action. These cases are common and are handled well, you wont have to run around for it as your case is straightforward and clear. You can sort this out easily.
 

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