QUESTION
Can my Doctors office refuse to cooperate with my insurance, charge me fees and co-pays, and make up their own prices on a whim?
Asked on Mar 21st, 2012 on Medical Malpractice - Texas
More details to this question:
My wife is undergoing Immunotherapy. When we started this process five months ago both our Insurance and the Doctors office assured us it would be 100% covered once our deductible was met. Since that time we have fought tooth and nail to get them to cooperate with each other. My insurance claims the doctor is submitting the bills with the wrong "codes", my Doctors says she refuses to use the "codes" my insurance instructed were the ones she needed to use, for reasons unknown to me.
None of my attempts to get my Doctor to resubmit the bills to my insurance using the "codes" my insurance wants have been successful, leaving me with an ever growing bill that both parties claim I am entirely responsible for unless this issue gets worked out. My wife goes in once a month for an office visit, SOMETIMES they charge her a co-pay of $25 dollars, sometimes they don''t. The office visit is ALWAYS for the same reason (to pick up her next months supply of materials). What can I do besides pay up?
1 ANSWER
Catastrophic Injury Attorney serving Roseland, NJ
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John J. Ratkowitz
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Unfortunately, this kind of behavior is the norm. Presumably, your insurance company is copying you on the correspondence when they are rejecting payment because of the inappropriate billing codes. You should continually harass the doctor's office until the comply with the insurance company's request. Send faxed correspondence indicating that their failure to comply with the insurance company's requests is risking a negative impact on your personal credit rating and insist that they resolve the issue.
Answered on Mar 21st, 2012 at 2:57 PM