S
slangdo
Guest
Hello-
I live in NJ. In August 2000, my wife visited a doctor who we did not know was a "preferred provider" in our health plan. She paid the full charge for the visit, $385, on the day of the visit.
When I called our health plan to see if were entitled to any reimbursement, the plan informed me that the doctor is, in fact, a preferred provider, and we should not have been charged anything until the doctor submitted a claim and the claim was settled.
I called the doctor's office; they agreed to submit the claim, but not refund any of the $385 they had charged my wife. (?) When they filed the claim, they indicated that we had paid nothing.
When the health plan settled the claim, the benefits form indicated that we should only be responsible for $19.00 of the charge for the visit. I have called and written to the doctor requesting a refund of the excess charge ($366), but my requests have gone unanswered. So the doctor has now been paid by us AND the helath plan.
I have our original canceled check from the payment for the visit, the explanation of benefits form from my health plan, and a copy of a letter which my health plan sent to the doctor indicating that the contract they have with the doctor restricts the doctor from charging us any more than the $19.00 copayment. Is this sufficient material to present in a small claims court complaint, and is small claims court the appropriate way for us to handle this?
One possibly complicating factor: We live in Morris County, the doctor's office was in Warren County at the time of the visit, and the doctor has now relocated to Sussex County. Which county's small claims court would we file in?
Thank you very much for any suggestions.
Steve Langdo.
I live in NJ. In August 2000, my wife visited a doctor who we did not know was a "preferred provider" in our health plan. She paid the full charge for the visit, $385, on the day of the visit.
When I called our health plan to see if were entitled to any reimbursement, the plan informed me that the doctor is, in fact, a preferred provider, and we should not have been charged anything until the doctor submitted a claim and the claim was settled.
I called the doctor's office; they agreed to submit the claim, but not refund any of the $385 they had charged my wife. (?) When they filed the claim, they indicated that we had paid nothing.
When the health plan settled the claim, the benefits form indicated that we should only be responsible for $19.00 of the charge for the visit. I have called and written to the doctor requesting a refund of the excess charge ($366), but my requests have gone unanswered. So the doctor has now been paid by us AND the helath plan.
I have our original canceled check from the payment for the visit, the explanation of benefits form from my health plan, and a copy of a letter which my health plan sent to the doctor indicating that the contract they have with the doctor restricts the doctor from charging us any more than the $19.00 copayment. Is this sufficient material to present in a small claims court complaint, and is small claims court the appropriate way for us to handle this?
One possibly complicating factor: We live in Morris County, the doctor's office was in Warren County at the time of the visit, and the doctor has now relocated to Sussex County. Which county's small claims court would we file in?
Thank you very much for any suggestions.
Steve Langdo.