Two health Insurance Questions

[BlkDragon]

What is the name of your state? West Virginia

I have two questions regarding health insurance.

1) A few months ago a family member got billed from the pediatrician for $300 some dollars. This money was the co-payment (80-20 insurance). So far so good. The ped. refused to accept monthly payments of $25, saying that was "unsatisfactory". Is there any law that deals with making payments for health bills not covered by insurance?

2) Today I recevied a bill from the same ped. for work done to my son. I became suspicious about this due to the fact that I never received an EOB from the insurance company. So I called the insurance company and they have no record of the bill being submitted. Is it legal to bill me WITHOUT billing the insurance co.? Note that this isn't a rejection of payment, the ins. co. never received the bill.
Thanks,
BD

 

[justathought]

1) Not that I'm aware of unless stated at the time of the visit. It's seen as a breach of contract, as in A gets paid for providing B a service. Service has been provided, so where's the money for doing so. Not good PR, but I don't think there's necessarily specific laws as breach of contract would suit the situation.

2) Sure. When you sign the dotted line at the peds office, there is undoubtedly a clause making you "ultimately" responsible for payments. You do have a few options: a) find attempt to submit the bill to the insurance company yourself--customer service of your insurance should be able to assist you with this, b) pay out of pocket now and use the necessary channels to get reimbursed through the insurance company or c) find a ped with a more efficient billing department. I admit, all of the options are a pain and you would think at the rising cost of insurance they might be a little more efficient, but ultimately you bear the responsibility for the bill (whether it be out of your pocket and/or insurance reimbursement for a covered service).

I just think your ped's office is guilty of bad PR, but not necessarily anything illegal or actionable. Maybe it's a fluke, maybe it's routine--that's for you to decide...

But I'm opining on generality, perhaps someone with WV experiences might be able to better assist you?

 

[CombatTN88]

Speaking of billing policy

When you visit a doctor's office, there is usually a sign posted on the wall saying that full payment must be made at the time of this visit. You signed that paper saying that it is OK for you to make the full payment or insurance do that.

 

[BlkDragon]

When you visit a doctor's office, there is usually a sign posted on the wall saying that full payment must be made at the time of this visit. You signed that paper saying that it is OK for you to make the full payment or insurance do that.

Actually, I don't recall seeing this, though it probably existed. If that was the case though, after we paid the co-pay and presented the insurance card, isn't that FULL payment?
BD

 

[justathought]

If that was the case though, after we paid the co-pay and presented the insurance card, isn't that FULL payment?
BD

But your first post implied that you didn't pay the full co-pay or you probably wouldn't be asking if partial payments are acceptable after the fact... So no there hasn't been "FULL" payment yet unless the post is being interpreted wrong. Which if that is the case, my humble apologies.

 

[BlkDragon]

But your first post implied that you didn't pay the full co-pay or you probably wouldn't be asking if partial payments are acceptable after the fact... So no there hasn't been "FULL" payment yet unless the post is being interpreted wrong. Which if that is the case, my humble apologies.

BTW, I got a call from the billing dept. today at the ped. He said that he would "resubmit" the bill. He tried to tell me that it was rejected, but when I called him on the fact I talked to the Ins. Co. he changed his tone and said "they must have made a mistake. I'll resubmit it". I was like yeah. Uh huh. That's what I thought.
BD

 

[justathought]

Cross your fingers and hope that it was a fluke or miscommunication.

I'm glad they're trying to resolve it for you.

 

[driftbuster]

my wife does medical billing.. so not to make excuses but she said it is really a pain. all of the different insurance companies, all of the different codes. what might work for one company will not work for another. if she or someone else puts in the wrong code (easily done because some codes are very much alike) it will be rejected. sometimes it gets resmitted with the same code becfore it is discovered and changed. so mistakes do happen, people get in a hurry. unfortunately we say " it always seem to happen to me" hope this sheds some light on the system.