sbrennan007
Member
Illinois-
Starting back in September of 2001 I started seeing a specialist, whom I was approved by my insurance and referred to by my primary doctor.
I started seeing this specialist on a regular basis and every visit paid my $15.00 co-payment. About 3 years after my first visit (yes, 3 years) I received a statement from this specialist's office stating that I owed $770.00. When I contacted them about this (I spoke with both the office staff and the specialist) they told me that their previous office staff was never on top of billing the insurance companies in a timely manor, and that since so much time had gone by the insurance would no longer accept the billings from the specialists office, hence telling me that I would now have to pay these charges.
I indicated to them that this was the first time I've ever received any notification of this and that as they could see my co-payments had always been paid. I told them I didn't see how it was my fault that their office never submitted the correct documentation to the insurance company (I have been with the same company for 12 years and have always received pre-approved insurance coverage for this specialist as required by the insurance company).
They then proceded to tell me that the insurance refused payment of these charges, so I asked them for detailed records of each time the bills were submitted to the insurance company and to identify what visits each billing to the insurance company was for. I have asked for this information now 3 seperate times, all requests for this information were sent via certified mail to the specialists office.
Today, now almost 5 years later I receive a letter from a collections agency stating that this account was turned over to them for collection. I contacted the collections agency and explained the entire situation and let them know that I have copies of certified letters and conversations with this office, non of which were ever returned.
Over the past 5 years now, in trying to get to the bottom of this and in requesting the above documentation, I have had several of the office staff tell me that this is nothing new for them and that the previous office staff was just horrible and never followed up with anything. They have notations on my account there of receiving all certified letters, but still to date have never sent me the information I asked for.
Am I responsible for this $770.00? As I mentioned above, I have had full insurance for more than 12 years now with the same company and always followed the correct procedure for obtaining referrals and approvals from the doctors and insurance companies..
What can I do here?
Thank you in advance for any assistance!
Sean
Starting back in September of 2001 I started seeing a specialist, whom I was approved by my insurance and referred to by my primary doctor.
I started seeing this specialist on a regular basis and every visit paid my $15.00 co-payment. About 3 years after my first visit (yes, 3 years) I received a statement from this specialist's office stating that I owed $770.00. When I contacted them about this (I spoke with both the office staff and the specialist) they told me that their previous office staff was never on top of billing the insurance companies in a timely manor, and that since so much time had gone by the insurance would no longer accept the billings from the specialists office, hence telling me that I would now have to pay these charges.
I indicated to them that this was the first time I've ever received any notification of this and that as they could see my co-payments had always been paid. I told them I didn't see how it was my fault that their office never submitted the correct documentation to the insurance company (I have been with the same company for 12 years and have always received pre-approved insurance coverage for this specialist as required by the insurance company).
They then proceded to tell me that the insurance refused payment of these charges, so I asked them for detailed records of each time the bills were submitted to the insurance company and to identify what visits each billing to the insurance company was for. I have asked for this information now 3 seperate times, all requests for this information were sent via certified mail to the specialists office.
Today, now almost 5 years later I receive a letter from a collections agency stating that this account was turned over to them for collection. I contacted the collections agency and explained the entire situation and let them know that I have copies of certified letters and conversations with this office, non of which were ever returned.
Over the past 5 years now, in trying to get to the bottom of this and in requesting the above documentation, I have had several of the office staff tell me that this is nothing new for them and that the previous office staff was just horrible and never followed up with anything. They have notations on my account there of receiving all certified letters, but still to date have never sent me the information I asked for.
Am I responsible for this $770.00? As I mentioned above, I have had full insurance for more than 12 years now with the same company and always followed the correct procedure for obtaining referrals and approvals from the doctors and insurance companies..
What can I do here?
Thank you in advance for any assistance!
Sean
