in another thread that I had posted "Serious help needed!" I had explained that I had an operation done in 2003, was suppose to be covered in full by insurance company. to make a long story short: Doctor left practice, started new one my insurance company paid doctors old practice. Doctor didn't know and is trying to sue me for $206.75 I explained to the billing company of doctors new office that it's a dispute between him and his old office. I had an office visit before the surgery coast was $116.00 insurance paid all but $49.00. They should of paid it in full. Called insurance and explained it to them they said that they could not reprocess it because it's way too old and to appeal the insurances decision, now I've tried appealing other bills with this insurance company and got NO WERE! My question is what can I do to get the insurance to step up to the plate and pay or reconsider their decisions! Any suggestion would be greatly appreciated thanks, Alexia
Is this the case where the insurance has paid both the old office, and the doctor's new practice for the same services performed by the same doctor?
yes, only I talked to someone new at the insurance company and they said that they only paid him once,but their was two claims from him submitted. then when I talked to someone from the insurance company the other day they said that he was paid out of network but then in network as well. I'm kind of getting the run around with the insurance company as well. the insurance company can not give me a copy of the bill in which the doctor summit ed and they can't give me a copy of the check in which they sent back. I did get a letter from the doctors first practice stating the charges are 1861.00 and my insurance company made two payments one for 1708.25 and another of 152.75. So my insurance paid the operation in full but the first visit was for 116.00 and now I have a balance of 49.00 from the 116.00 and I know that the insurance company should pay that as well. thanks so much I was hopping that you would read this. Alexia
Has the insurance company sent you an Explanation of Benefits for each payment they made? Can you get a copy of the bill, and statement showing insurance payments for the account, from the first practice?
Maybe the insurance should pay the first visit, but that was thru the old practice as well, I presume. If you were never seen by this doctor thru his new practice, but only thru the old practice, then the old practice should be the only ones billing either your insurance or you. Any billing thru the new practice will be out of network, and erroneous, if the services were performed by the old practice in network.
