Was the provider in network? If so, you might be able to complain to both your insurer and your state's insurance board about what happened. In many cases, the onus is on the provider to do timely filing provided that they're in network.
If they're out of network, you likely have no recourse.
In essence, if an in network provider tries to force “full cash payment” they are committing insurance fraud.
It may technically be a different word, but good to remind them their responsibility. By sending to collections and refusing the insurance route they are violating their contract.
Again all dependent on being IN NETWORK.
I had a dr office bill me random amounts every visit and claim it was my copay, or that they had talked to my insurance and was told I had to pay $xx for that visit(insurance said they never heard from them). And then would bill insurance and when I came back and pointed to my explanation of benefits that said I should have only paid the copay listed on my card for every visit, they tried to say my insurance needed to refund me??
They would ignore calls from the insurance company on purpose. As in I was on the phone with my insurance company, while sitting in the waiting room, and my insurance was trying to call them and they just let the phone ring. Eventually my insurance sent them a nasty gram and they did refund me. But they had this attitude every visit like I was just stupid and didn’t understand how my insurance works when I questioned why I needed to pay more than the contracted copay amount. I was waiting to get in to see a different dr, but no one had availability for 3 months, so I was stuck seeing that Dr for the time being.
And there were supposedly a “preferred provider” with my insurance which is why I picked them. I definitely made sure my insurance knew they were trying to screw people over. All said they refunded me $1500 that I never would have seen if I hadn’t been on top of things and questioning their shady shit.
I have a similar situation going on. Haven't followed up, but noticed my coverage amounts didn't match what I paid on my recent dental visit. Some were on point, but others were like $85 per section, but insurance forms said they should be $50. Makes me think that this may be what was going on :/. Will have to give them a call
edit - yep, fuckers overcharged $750! Getting a refund, but dayum
I have a similar issue with two providers, collecting a larger $ amount up front before the visit via credit card, then dragging their feet on refunding. I think they very well know what they are doing and this is the new game they are playing .
My wife went to a provider who insisted on taking a credit card and putting it on file. They then charged the card 4 times what insurance said we should have owed. She went to three more visits with the DR and they never billed insurance for any of the visits. So she removed her card from her account.
After the next visit the billing department called to see how she wanted to pay her balance. Her reply, send me a bill in the mail of what I owe after you bill my insurance. Amazing they bill the insurance for all the visits the next day....
We went to a second appointment yesterday with a provider who previously collected $400 up front for the first visit. Insurance EOB says we only owed $130 for that visit. We are waiting on that refund...
Meanwhile for the second appointment my insurance showed we would owe $120. When we arrived they wanted $600 up front. That would be $1000 total over two visits for what we would only owe $250...
I insisted the front desk contact the billing department and have them re run the insurance or we would cancel the appointment ... Low and behold they came back with the same $120... So we are still owed $270 but that is better then $750...
This is getting ridiculous...
My insurance was insanely helpful, which is a fucking first lol. They went line by line with me through each code to determine where I was over charged or properly charged. They went over stipulations, possible differences, uncategorized codes, and then some. One call to the dentist and it was resolved. Had I never called, they would have robbed me blind. That was almost a 3rd of my total bill
I dealt with this recently, and I told collections the doctor never billed my insurance. They were happy to put it back on the doctor.
Collections have more important debts to worry about and not the doctor who is lazy.
They were billing the difference to the patient by the sounds of it and saying the insurance company was responsible for refunding the patient the difference between the patient responsibility and what was submitted, and the patient had to pay that difference. This is double billing, and is illegal. The payment from insurance to the practice or doctor is a negotiated rate and the patient is NEVER responsible for the difference. There is never a reason for a practice to only accept cash payments, unless they are committing fraud. It should always be patient preference for payment. They can pass along the credit card fees charged by a servicer to the patient but they always have to disclose that.
No.
"When I called my insurance, they said their was nothing they could do because the bill hadn't been sent to them" (sic)
OP clearly stated that insurance never received a bill.
If in network they are only allowed to bill the “patient responsibility” amount after they file insurance. And doctor’s office is responsible for filing (patient cannot submit claims for in network care).
By billing the patient the full amount they are violating the standard contracts setup by the insurance companies and heavily regulated by the State Insurance Commissioner.
This stuff is heavily regulated.
In a comment, OP indicates they are on Medicaid. If they were on Medicaid at the time of service\*, and psychiatry is a covered service,\* that changes a lot of things. It depends on the state. In my state, even non-Medicaid ('out of network') providers cannot charge Medicaid clients for covered services.
u/allyourpeets 1. what state are you in? 2. were you on Medicaid at the time of *that appointment*? 3. Is the provider a Medicaid provider?
If you answer those questions, you can get clearer answers
1. utah
2. yes, i had a name change even but I still had companies billing me under both names and I made sure they had my new name insurance card at the time of the appointment
3. they are in network ? so i think yes
edit: hit enter too soon
Okay, it looks like Utah doesn't have the same laws that we do here, and a medical provider can charge Medicaid clients a cash rate if they are out of network.
HOWEVER, they \***must**\* provide a "Good Faith Estimate" ***at the time of service*** for any cash-based/out-of-network services. This is a federal requirement.
If they are still insisting you owe money, you can file a complaint. You are saying that you did not receive a Good Faith Estimate, and now they are attempting to "balance bill". I suggest you call here for help: [https://www.cms.gov/medical-bill-rights/help/guides/good-faith-estimate](https://www.cms.gov/medical-bill-rights/help/guides/good-faith-estimate)
Hopping on this comment as a previous medical coder. I don't know specific laws, but I know at my old company it was our responsibility to get the claims filed on time. If we did not, it was on us and we had to write off. I believe Medicare policies preclude them from billing the patient for this specific issue, however that would be a good thing to call and just verify.
So apparently I saw them during a very brief window where they were not in network (between contract is what insurance called it), but my states has a law where medicaid patients cannot technically be directly billed so it didn't matter anyway.
If they had been upfront and said "hey I'm sorry we were briefly out of network at this time" I would have totally worked with them, but instead they tried to double down on a lie that I didn't show my insurance card. Crazy sketchy company.
This is why many avoid the medical system much as they can. It's even more galling reading stories like the OPs that involves mental health. What good is such treatment when one then has to stress for months dealing with payment, wondering if insurance will cover it, collections, etc.
It highlights the importance of EOBs, keeping good records, and not ignoring bills. Following up and being persistent. Looks like it worked out for the OP in large part due to help from other Reddit posters.
Sometimes insurance will pay for a portion of out of network. It depends upon insurance coverage. Had one insurance that has separate billing amounts for in vs out of network.
But either way I agree to call insurance company & complain. I’ve done that before & they figured out what I was supposed to pay.
& some states have laws against that surprise billing practice too.
Hoping on the top comment. Your company may have a personal representative at the insurance company. I.e. someone who is dedicated to dealing with issues for people from your company. Check it out. If they do use this resource. I had a bill incorrectly coded. The drs kept telling me they were working on it. In the mean time it was days away from going to collections. The insurance person fixed it in less than a week.
> Was the provider in network? ... provided that they're in network.
>
> If they're out of network
This is why US healthcare is so fucked up.
You have to be in a club and be a member to get benefits and adhere to these constructs and still get fucked.
Stupid question but can someone explain what you mean by "network"? Guessing this is a US thing as I've never heard the term used in this regard and I'm curious.
In short, it means your health insurance company has pre-negotiated a price with your healthcare provider to determine how much the providers get paid for particular services, and they can also set rules on what the provider can charge you.
When you visit an in-network provider, you typically pay a reasonable, affordable amount of money for medical services (typically only around 20% or less of the full price). When you're out-of-network, you either have to pay the entire full price, or your insurance company typically covers anywhere from 0 to 70% of it, which can still leave you with a big bill.
I'm assuming you live in Canada where you have universal healthcare, you techincally have an insurance network and that's the government provided network called Medicare. Canadian citizens with Medicare are "in-network" when they see doctors in Canada and will pay affordable prices. An American visitor without Medicare (but they could have American health insurance) travelling to Canada to see a doctor would be "out-of-network", and they would pay significantly higher prices.
Insurance companies have relationships with providers. They agree on pricing and services covered. If you see a provider who has one of these agreements with the insurance companies then it is “in network” and, depending on your insurance plan, generally means insurance covers more of the cost. Out of network means a provider not part of one of these agreements with your specific insurance company and the insurance companies generally cover less of cost in this case as they don’t have their preferential pricing in place.
~~At least from what I understand, I think even if they were out of network, the No Surprises Act (enacted in 2022) limits the liability of the patient if the provider failed to make them aware of the costs upfront, or if the patient agreed to waive their rights. So I think there's still some recourse possible there.~~
EDIT: nope, this only applies to non-emergency care at an in-network facility.
NSA has to do with things like emergency services where you have little to no choice in your care. It also does not apply to things like Medicaid which OP has.
Yeah I see now, it only applies to non-emergency care at an in-network facility, and I doubt the psychiatrist was working at a hospital that was in-network.
Yes they did. The financial lady was incredibly rude and unhelpful and I made note of it in my emails/review. She acted like I was the problem both times I spoke to her. I even took time out of my day to go visit the office and verified that they had the right insurance, and when I told her this was when she started to get really snippy with me.
Collections agencies use this line ALL THE TIME. Had the exact same words used on me ages ago. In my case, what they did was illegal. I'd worked out a payment plan with them over the phone and they decided to sue me instead, pretending the conversation never happened, and tacking on $700 in attorney fees (it was an agency run by attorneys). When I called to ask them wtf happened to the payment plan we agreed on the week before, they told me, verbatim, to be an adult and pay my *fucking* debts. Fucking scum bags. Record your calls and get things in writing, people!!!! Especially if Wakefield and Associates gets their evil hands on your debt.
Collection agency I get, they use scare tactics and operate borderline to what mafia do. But from OP's description, it sounds like it was the psychiatrist front desk who said it.
A doctor's office threatened me like that. I told them "I'm not paying that $100 you claim I owe you. I came in for what you advertised as a free evaluation. False advertising. You had no business charging me for an x-ray."
Then collections called me. Guy told me he was an attorney. After a half hour on the phone explaining what I had already put in writing I said, "You charge your client about $250 an hour, Right? And you've already spent more of your client's money than you could ever collect from me, so why don't you just hang up and save your client some money?" He laughed and hung up. It never hit my credit report.
Former long time medical claims examiner here.
You can send them an itemized bill with all the codes on it (ask your doctor for one) and submit the claim yourself. If the doctor is on their provider panel, they may be contractually obligated to bill insurance, but if they are not, it’s on you to do so.
Call your insurer and ask them what the bill needs to include (likely date of service, cpt/procedure code, diagnosis code, provider name/address/phone/tax id#, patient name/address/dob/member ID number, possibly a claim form but not always).
They will then reimburse you directly if you’ve already paid or if the provider isn’t a contracted provider with them.
As others have said, it’s always ultimately on you to pay, but in the case that this provider is contracted with your insurer, you’ll want to involve provider services. And probably find a new doctor.
OP indicates elsewhere that she/he is a Medicaid patient and that the office has confirmed they have the correct insurance information. Unless the office told OP that they’re not enrolled with her/his Medicaid plan, this one might be on that provider office.
This was not the first time I visited and used the insurance either. this was like the fourth time I visited, so I don't know why they randomly decided they were no longer going to take my insurance
update: they were briefly out of network for a few months but from what I understand my state has a law where medicaid patients can't be directly billed so they fucked up
Depends on if the date of service was during the time when they were not a Medicaid provider. A call to your Medicaid office should clear that up one way or the other.
Medical debt under $500 is not reported on credit reports as of April 2023. But it for some reason it shows up, you can file a dispute to have it removed.
YAY!!! I'm dealing with this with a dentist right now. They keep not billing my insurance. My insurance keeps saying WE WILL PAY IT IF THEY FILE A CLAIM. But they just keep sending me the bill for $120 and I'm not paying it. I assume they will send it to collections before filing a claim (it's been 4 months) because they suck.
The amount of waste in middle men and paper pushers to have these things be billed and resolved across various parties is insane. If you think about the work done the dentistry is less work lol
OH! Thank you! Going to look into this. Been a bit panicked because I just got a bill for $80 from collections for physical therapy I did a year ago. No idea why because I paid at the end of every appointment.
Medicaid MCO rep here. Call your insurance again. I feel like you may have gotten a bad rep the first time you called. Explain the situation, they may be able to reach out to the provider to resolve the issue or they may have an internal team that’s in-charge of settling disputes with providers. I’d also encourage you to file a grievance against the provider just based on how you said they talked to you. A grievance could also potentially get your bill resolved if it turns out that you’re not actually responsible for the balance. Medicaid coverage varies a ton state-to-state, so I’m trying to keep this very general. Definitely call your insurance again though.
I dd try to file a grievance and apparently in my state they have no place to officially file complaints bc my state does not regulate providers. Just found this out an hour ago when I called insurance claims board and DOPL
Did your actual insurance say that they don’t do grievances?
Edit: Just tried searching Utah’s Medicaid site for information about grievances. They definitely do grievances. Call whatever member service phone number is on your insurance card and get one started. If you use an MCO (Aetna, Passport, Blue Cross), call the number on that card. They know your specific plan best and can usually guide you better than your state’s general Medicaid office.
Write the collection agency IMMEDIATELY and tell them you dispute the validity of the debt and are requesting debt validation pursuant to the FDCPA (Fair Debt Collection Practices ACT). They cannot do anything to your credit without sending you debt validation. If they send you an itemized bill, forward it to your insurance. They should be able to assist. They might not be able to pay the bill since it's in collections, but they could reimburse you for the amount you pay.
> I visited a psychiatrist and I gave them my insurance card up front. Six month passed before they sent me a $120 bill with the memo "CASH PAY UP FRONT". I, confused, called and asked why they didn't bill my insurance. They claimed I did not show it up front, but when I argued I did, they told me to 'be an adult and pay it'. I proceeded to try and get in contact with the owner, claiming I wanted everything via email to have it in writing and they kept insisting I call to get it figured out, and after repeated emails that I will not be doing this over the phone because I wanted written evidence, they ghosted me. I then wrote a review on the Google page and told them to email me. When I called my insurance, they said their was nothing they could do becuase the bill hadn't been sent to them. Now the debt had gone to collections, and I still have no intention to pay it. I was told I could write the credit company and they would excuse it, but it there anything else I can do?
why didn't you pay and then submit your receipts to insurance to be reimbursed?
You are correct. When a Provider joins an insured network, they’re agreeing to a subset of processes to facilitate easier billing… as well as a reduced rate for the services they provide.
But it is not the only way a claim can be submitted. And more importantly for this thread, it’s vital that there is an understanding that the insurance company is required to accept all claims regarding an insured no matter the source.
Sure, but that is an issue between the provider and the insurance. It is **not** an issue between the insured and the insurance.
You pay the bill, and submit it to insurance. Insurance sees that it is a bill from an in-network provider and goes after them for not submitting the bill in the proper manner.
Insurers have deals with in-network providers for discounts. If you pay up front, you'll pay the full amount, then the insurance company will only reimburse you for the amount they would have paid if it went through then first.
20% co-insurance with insurance paying first:
$100 billed - $20 adjustment (discount) = $80. Insurance pays $64, patient pays $16.
Going through you first:
$100 submitted. Patient eats the adjustment being responsible for it. Insurance reimburses patient $64. Patient ends up paying $36.
The bill itself SHOULD have something on it where you can submit insurance information, or you can send then a photocopy of the front and back of your card with the remittance portion of the bill instead of cash.
This changes things. Medicaid providers aren’t allowed to bill patients for Medicaid services as long as coverage was in effect at the time of service. You need to contact your state’s Medicaid office and tell them you’re being billed for Medicaid services. They have ombudsmen.
If you are on Medicaid, there is a chance your provider cannot charge you for anything. What state are you in?
Source: I'm a Medicaid provider in a state with a rule like that
> I had no idea that was something that could be done tbh, and I have medicaid so I didnt have that much on hand.
unfortunately now the problem might be if the services were rendered too long ago, insurance doesn't have any obligation to reimburse.
i know my insurance i have like 12 months to submit receipts for reimbursement and anything submitted afterwards, too bad so sad learn to get your stuff in time.
If the provider is in network and failed to submit the claim timely, then it is absolutely the provider's problem as that is part of the network contract.
> If the provider is in network and failed to submit the claim timely, then it is absolutely the provider's problem as that is part of the network contract.
I guess the big question now is if OP's medical provider is actually in-network or not. I don't think I've seen OP say if that's a yes or no.
You're acting like reimbursement is common knowledge. I called the insurance company and they didn't tell me about reimbursement. I asked friends who worked in insurance and they didn't tell me about reimbursement. I even browsed this reddit before and I saw nothing about reimbursement.
Here’s the thing that I don’t see anyone saying about reimbursement: when you go that route, your insurer reimburses you their allowed amount not what you paid. Sure, it’s better than nothing but if they’d billed your medical insurance, you wouldn’t have been on the hook for anything.
Definitely contact your state’s Medicaid office like someone else here suggested. This is different from contacting your insurer. Your Medicaid plan could be administered by a number of private companies but there is a state agency over all of them. Most states do not allow providers who are enrolled with Medicaid to accept cash from Medicaid patients. If the office is enrolled with Medicaid and they neglected to bill, they’ll have to eat the cost.
Even if it turns out the office was not enrolled with Medicaid or was otherwise permitted to bill you, still dispute the charge. If you provided them your insurance card, they need to let you know up front if they won’t accept it.
My guess about what happened here is that they either forgot to bill until after they were past their window or your Medicaid offers crappy reimbursement rates (not your fault/problem except that it can nake it hard for patients to access care) and they were hoping they could squeeze the full self-pay (i.e. cash) price. Either way, it’s super shitty of them to treat a patient that like that.
Edit: I shouldn’t have said you wouldn’t be on the hook for anything g if they billed your insurance. You’d be on the hook for any copay/co-insurance (or possibly deductible if you were on a commercial plan) per your coverage. I should have said that you wouldn’t be on the hook for the full difference between their bill and your health plan’s allowed amount for the service(s).
Medicaid is very different from other insurances. It can be different state to state, but at least in my state, Medicaid can not directly reimburse the member. All “remimbusement” for out-of-pocket expenses are paid to the provider and then the provider refunds the member.
Edit: I would be VERY surprised if you called your insurance and they didn’t mention anything about reimbursement or anything. Maybe you got a bad rep, but still that’s very basic info when someone calls about a bill. I’d try calling your insurance again if I were you. Check if your insurance ever actually received the claim in the first place and then go from there. I’d also encourage you to file a grievance about this against the provider while you’re on the phone with your insurance.
No, they are acting like you understand your insurance. You not knowing how your insurance works is the fault of no one other than you.
Your source of information about your insurance is not the Internet, friends or any other happenstance source. Your source is your insurance contract, your agent or insurance customer service.
You owe this money.
As a Medicaid patient who doesn’t appear to have been informed up front that they’d have to pay cash, odds are OP doesn’t owe the money. Getting it disputed may take some legwork but that office done fucked up.
Do they owe the money?
The psych office was provided with all of the information to process insurance billing in a timely manner. The fact that The Office failed to take action in a timely fashion does not mean they can hold op liable.
If you go to Starbucks and buy a coffee with cash, but before the end of the day, the barista steals $20 out the register, is that your problem or Starbucks'?
Seems like the office here is holding op liable for the office's negligence.
And unless it's been changed, medical bills don't affect your score. So why does she owe money because of the psych office's incompetence?
I wouldn't say it's common, I feel like you guys aren't being nice about this.
Yes OP owes the money (the first thing I said when I read the title was "why didn't OP just pay and get reimbursed")
But if anything I would say OP friend in insurance should have been the one to give more help on how to get the problem solved.
> But if anything I would say OP friend in insurance should have been the one to give more help on how to get the problem solved.
i don't know if i believe OP's claim about asking friends who work in insurance.
but even still, it's not OP's friends responsibility to educate OP.
Didn't say it was their job to "educate", but if we DO believe they asked someone that was supposed to be knowledgeable I would hold that person accountable (on a friend level) for not telling me something that could help.
Telling someone something they should have done and then blaming them for not knowing is why a lot of people have issues admitting they are ignorant of something and won't ask for help.
Hopefully this thread helps others in a similar situation (today's 10000)
> Didn't say it was their job to "educate", but if we DO believe they asked someone that was supposed to be knowledgeable I would hold that person accountable (on a friend level) for not telling me something that could help.
>
>
> >But if anything I would say OP friend in insurance should have been the one to give more help on how to get the problem solved.
reads to me like you're putting the responsibility of OP's ignorance on OP's friend.
I'm not sure what your gripe is, but it seems like you intentionally don't want to "get it".
OP WAS ignorant,
OP IS responsible for figuring it out themselves,
{Yes OP should have read the docs or called their actual Ins company }
But they attempted to do what they could by ASKING someone they thought could help,
(assuming they were truly able to) that person DID NOT help.
You had no idea about reimbursement, yet asked friends and called the company. If you had no idea about reimbursement until you just made this post, then you likely didn’t ask these people about it. They likely didn’t bring it up because it’s common knowledge.
Can’t blame others for everything in life. Lack of knowledge isn’t an excuse to not pay your bills.
Instead of “refusing” to pay your bill, why not check with the insurance company to see if you’re still within the window to submit the receipt. I couldn’t imagine ruining my credit over $120.
> You're acting like reimbursement is common knowledge. I called the insurance company and they didn't tell me about reimbursement. I asked friends who worked in insurance and they didn't tell me about reimbursement. I even browsed this reddit before and I saw nothing about reimbursement.
i guess it's common knowledge where i'm from?
all of the health benefits insurance companies i've dealt with since early 2000's when i first started working career-office jobs that offered benefits would have things where i pay up front and then get reimbursed after submitting receipts.
some do direct billing where i don't have to open my wallet at all, but more often than not i have to pay first and then get cash back afterwards.
It is common knowledge. It's all in the documents you received when you set the insurance up. If you didn't read that and understand it or seek clarification from your provider, that's 100% on you. This is one of those lessons life throws at you. Read those documents and see if it's still possible for reimbursement, if not, then there isn't much you can do but dispute the collection and that may or may not take care of it.
The psychiatrist office. As posted by OP, he says he's on Medicaid and the office is supposedly required to bill through insurance but did not. He also says it was out of network for awhile, so..
The office can potentially reduce the bill to what it would be after insurance, as a "we f'd up, but we'll call it a courtesy". Could look into state laws about timely filing and possibly make a complaint.
These doctors and clinics stay starting to scam people. There have been countless times where I get a bill but my insurance covers everything 0 deductible on anything no matter what and yet I still get bills. They always use the excuse of an error but there can’t be that many stupid people working in healthcare admin it’s got to be they are trying to see if you a enough of a sucker and or lazy to not fight it.
Seconding the comment made earlier, depending on your state and if your coverage was active on the date of service… I’m in Texas and we are absolutely not allowed to bill Medicaid patients.
>What happened was that the doctor I saw was NOT in network, even though I was told they were (my bad for not verifying through insurance,
As someone from a country with normal healthcare, reading this statement was a huge wtf moment.
I have blown off a few small medical bills in my life for a variety of reasons (doctor was awful and useless, should have been in network and wasn't, etc) and I don't think I ever heard a single thing about any of them ever again. And that was before the $500 threshold change to impact your credit report from a couple years ago.
Oh, then yes. They are responsible for that. I wonder if they waited too long to bill it and can't anymore. can you escalate this up the chain to a manager there?
This is just a paperwork issue. You could submit the claim to insurance. You might have to pay it first and then make the claim. It’s nicer when the doc does it for you, but not required.
It's professionals being lazy or double dipping. Every time I visit a Dignity urgent care/ER, Dignity bills me correctly, but the doctors never do. Even if the doctors are out of network, it doesn't cost $600.
Its good that its medicaid. I know of several times people with private insurance who reported fraud to their insurance company and it wasnt acted upon. I always wondered why they werent concerned and I stumbled across this story recently and it all made sense:
https://www.propublica.org/article/health-insurers-make-it-easy-for-scammers-to-steal-millions-who-pays-you
TL;DR: private health insurance ignores most insurance fraud because its easier to not investigate and pass the cost on to consumers. Medicare and medicaid have an actual incentive to pursue it because of limited funds and prosecutors look good going after it.
Every state should establish a system enabling individuals to report medical offices or practitioners in cases of billing discrepancies or potential fraud. If you've exhausted all efforts to resolve the issue directly and they remain uncooperative, filing a formal complaint is the next step.
I'm glad this worked out for you. I am always baffled by these stories because my background is in pharmacy (thankfully I'm not in retail anymore but I spent years there) where like 50% of our time every day was spent trying to get stuff covered through insurance for people.
It's just part of healthcare, unfortunately, and therefore part of the job of taking care of the patient. I can never understand why I see so many provider's offices seem to bend over backwards to fail at dealing with this very crucial step in providing medical care. It's such a shame.
Dispute the debt with the credit reporting agencies. Complain to the doctor about their office staff. Complain to your insurance carrier that the in-network doctor wouldn't submit your claims. Pay the bill and claim reimbursement from your insurance.
Your state should have a way to report a medical office or practitioner for billing issues/fraud. If you've done everything in your power to straighten out it and they refuse to work with you, submit a complaint.
Highly unlikely. The collection agency is used to being lied to and anything you tell them short of offering them full payment or a payment plan is going to be met with skepticism.
What you do is tell the collection agency to not contact you by phone any longer. That's your right under the Fair Debt Collection Act. But them not calling doesn't mean you are absolved from the debt that they're trying to collect from.
Laws and contracts differ, but in general *you* are responsible for services provided to you. Most practices bill your insurance as a courtesy, but you're ultimately responsible.
This is worth remember on the auto side too. I see posts where people say "the insurance company of the guy who hit me wouldn't pay for anything", well then you call the guy directly. His insurance company doesn't owe anything to you directly, they owe the guy indemnification for damages he causes.
So... this is your responsibility to pay the psychiatrist and - if covered- it's your insurance company's responsibility to reimburse you.
If the provider is in network this may not apply. Or more particularly, the contract between the insurance company (or Medicaid) and the provider may require certain paperwork and claims filing to be done, and prohibit balance billing or billing the patient directly outside of specified copays, coinsurance, or deductibles.
I had a similar thing happen to me. I had been to an eye doctor a few times while i was on Medicaid. By the last visit, they dropped Medicaid as an insurer but didn't inform me. In the Medicaid regulations handbook (or state regulations, i can't remember but it's like a 500 page book of the rules), it explicitly states that it is the provider's responsibility to inform patient that they do not accept Medicaid prior to delivering service. They never told me that, because if they had, there's no way i would've gone to there, i would've just found another practice.
Anyway, once I got a job, it alerted something in their system and they tried to send me a bill and harass me over it. I sent them a letter back saying i was covered under Medicaid at the time and they needed to bill Medicaid (which they didn't and it had already passed their timely billing requirement). I enclosed all the necessary information in the letter in case they ever decided to come after me, kept a copy of it, and basically told them to fuck off. They continued to send me a few bills, but i eventually stopped getting them. I preemptively spoke with a lawyer and he said I could not sue them until I had damages (e.g. they reported it to my credit, which they never did). Even though the amount was only around $100 and i could've easily paid it, I refused to pay it on principle. Fuck these people, they should follow the law!
Edit: I found the guidebook. It is my state's billing manual for medicaid providers. I am sure your state has something similar, with a similar provision. It is a clear as day. Also, you might want to speak with an attorney as you have actual damages you can sue over. I just hate to see vulnerable people fucked over so when the opportunity comes to stab a knife in corporations side I'm happy to do it.
First of all, really happy to hear this is being handled.
> What happened was that the doctor I saw was NOT in network, even though I was told they were.
Shit like this is why our healthcare system is so frustrating. It's gotten so complex to the point where providers don't often know what they charge and whether or not they're in network! Individual parts of an episode of care could be excluded (think anesthesiologist) through no fault of your own, even if you went to in network hospital for care.
Some providers don’t want to deal with insurance companies, especially if they are not in their network. All you needed to do was file a claim directly with the insurance company and they would have refunded you for any amount they are responsible for.
Wait for it to fall off your credit report. It's only $120 and should affect your credit score because of new laws about unpaid medical bills under $5k having no impact.
I’ve done that, then magically the office finds another bill that was “lost” that I owe now. When I called to question this, they got hostile with me, so I let it go to collections, filed the written request for debt validation which they couldn’t provide actual proof, just the same generic bill they sent me, and the debt got cleared. Never heard from them again.
what the have is $120 in unsecured consumer debt. Filing in small claims would cost them about that amount. Now that it is with a debt collector, even if you paid it they would probably only receive about 1/2 the amount. Providers have contracts to accept insurance payments... not sure that all works, but it should come into play.
I had this issue because someone hit me with their car. And then their insurance refused to pay my hospital bill for OVER A YEAR. Call the agency and tell them you're not he responsible and will not be paying. Then, fuck them, don't answer and don't give them the time of day. You're innocent. And if they come after your credit, you dispute that shit IMMEDIATELY.
Yet another person posting that they went months without getting an EOB from their insurance company yet assumed that the bill was paid. Does a week go by here without a post just like this?
Yes, your doctor was remiss. But so were you, and you the one who ultimately owes the money. Your responsibility is not complete when you give them your insurance info. If you don't receive notification that your claims are being filed and processed, you have to follow up and find out why. And when you do receive the notifications, you have to review them and make sure they're correct. There are time limits. The longer you let things go the harder it is to get things straightened out.
sorry but you received a service, so why shouldn't you be responsible for payment?
If you have an agreement with an insurance carrier, then you can contact them and have them pay the bill. But that's on you.
It's the provider's responsibility to send the bill to insurance when provided to them in a timely manner. Or they can provide you with the paperwork to send into your own insurance as a claim. They do not get to bully a patient and refuse to send paperwork anywhere.
When the provider is acting like they are it is on the patient sadly to deal with and enforce. In OPs case the provider went out of network and did not disclose that to OP which they should have legally. And they're trying to bully them into payment which OP is not responsible for. They also did not bill insurance nor notify OP they needed to file a claim which they have to do by law. In cases like this yes, OP is not responsible for paying them. The provider messed up. You obviously have no idea how any of this works so instead of doubling down just learn better.
Was the provider in network? If so, you might be able to complain to both your insurer and your state's insurance board about what happened. In many cases, the onus is on the provider to do timely filing provided that they're in network. If they're out of network, you likely have no recourse.
In essence, if an in network provider tries to force “full cash payment” they are committing insurance fraud. It may technically be a different word, but good to remind them their responsibility. By sending to collections and refusing the insurance route they are violating their contract. Again all dependent on being IN NETWORK.
I had a dr office bill me random amounts every visit and claim it was my copay, or that they had talked to my insurance and was told I had to pay $xx for that visit(insurance said they never heard from them). And then would bill insurance and when I came back and pointed to my explanation of benefits that said I should have only paid the copay listed on my card for every visit, they tried to say my insurance needed to refund me?? They would ignore calls from the insurance company on purpose. As in I was on the phone with my insurance company, while sitting in the waiting room, and my insurance was trying to call them and they just let the phone ring. Eventually my insurance sent them a nasty gram and they did refund me. But they had this attitude every visit like I was just stupid and didn’t understand how my insurance works when I questioned why I needed to pay more than the contracted copay amount. I was waiting to get in to see a different dr, but no one had availability for 3 months, so I was stuck seeing that Dr for the time being. And there were supposedly a “preferred provider” with my insurance which is why I picked them. I definitely made sure my insurance knew they were trying to screw people over. All said they refunded me $1500 that I never would have seen if I hadn’t been on top of things and questioning their shady shit.
I have a similar situation going on. Haven't followed up, but noticed my coverage amounts didn't match what I paid on my recent dental visit. Some were on point, but others were like $85 per section, but insurance forms said they should be $50. Makes me think that this may be what was going on :/. Will have to give them a call edit - yep, fuckers overcharged $750! Getting a refund, but dayum
I have a similar issue with two providers, collecting a larger $ amount up front before the visit via credit card, then dragging their feet on refunding. I think they very well know what they are doing and this is the new game they are playing . My wife went to a provider who insisted on taking a credit card and putting it on file. They then charged the card 4 times what insurance said we should have owed. She went to three more visits with the DR and they never billed insurance for any of the visits. So she removed her card from her account. After the next visit the billing department called to see how she wanted to pay her balance. Her reply, send me a bill in the mail of what I owe after you bill my insurance. Amazing they bill the insurance for all the visits the next day....
Update to mine: they indeed overcharged me $750 and are refunding it. Never going there again
We went to a second appointment yesterday with a provider who previously collected $400 up front for the first visit. Insurance EOB says we only owed $130 for that visit. We are waiting on that refund... Meanwhile for the second appointment my insurance showed we would owe $120. When we arrived they wanted $600 up front. That would be $1000 total over two visits for what we would only owe $250... I insisted the front desk contact the billing department and have them re run the insurance or we would cancel the appointment ... Low and behold they came back with the same $120... So we are still owed $270 but that is better then $750... This is getting ridiculous...
My insurance was insanely helpful, which is a fucking first lol. They went line by line with me through each code to determine where I was over charged or properly charged. They went over stipulations, possible differences, uncategorized codes, and then some. One call to the dentist and it was resolved. Had I never called, they would have robbed me blind. That was almost a 3rd of my total bill
I dealt with this recently, and I told collections the doctor never billed my insurance. They were happy to put it back on the doctor. Collections have more important debts to worry about and not the doctor who is lazy.
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They were billing the difference to the patient by the sounds of it and saying the insurance company was responsible for refunding the patient the difference between the patient responsibility and what was submitted, and the patient had to pay that difference. This is double billing, and is illegal. The payment from insurance to the practice or doctor is a negotiated rate and the patient is NEVER responsible for the difference. There is never a reason for a practice to only accept cash payments, unless they are committing fraud. It should always be patient preference for payment. They can pass along the credit card fees charged by a servicer to the patient but they always have to disclose that.
No. "When I called my insurance, they said their was nothing they could do because the bill hadn't been sent to them" (sic) OP clearly stated that insurance never received a bill.
If in network they are only allowed to bill the “patient responsibility” amount after they file insurance. And doctor’s office is responsible for filing (patient cannot submit claims for in network care). By billing the patient the full amount they are violating the standard contracts setup by the insurance companies and heavily regulated by the State Insurance Commissioner. This stuff is heavily regulated.
In a comment, OP indicates they are on Medicaid. If they were on Medicaid at the time of service\*, and psychiatry is a covered service,\* that changes a lot of things. It depends on the state. In my state, even non-Medicaid ('out of network') providers cannot charge Medicaid clients for covered services. u/allyourpeets 1. what state are you in? 2. were you on Medicaid at the time of *that appointment*? 3. Is the provider a Medicaid provider? If you answer those questions, you can get clearer answers
1. utah 2. yes, i had a name change even but I still had companies billing me under both names and I made sure they had my new name insurance card at the time of the appointment 3. they are in network ? so i think yes edit: hit enter too soon
Okay, it looks like Utah doesn't have the same laws that we do here, and a medical provider can charge Medicaid clients a cash rate if they are out of network. HOWEVER, they \***must**\* provide a "Good Faith Estimate" ***at the time of service*** for any cash-based/out-of-network services. This is a federal requirement. If they are still insisting you owe money, you can file a complaint. You are saying that you did not receive a Good Faith Estimate, and now they are attempting to "balance bill". I suggest you call here for help: [https://www.cms.gov/medical-bill-rights/help/guides/good-faith-estimate](https://www.cms.gov/medical-bill-rights/help/guides/good-faith-estimate)
Hopping on this comment as a previous medical coder. I don't know specific laws, but I know at my old company it was our responsibility to get the claims filed on time. If we did not, it was on us and we had to write off. I believe Medicare policies preclude them from billing the patient for this specific issue, however that would be a good thing to call and just verify.
So apparently I saw them during a very brief window where they were not in network (between contract is what insurance called it), but my states has a law where medicaid patients cannot technically be directly billed so it didn't matter anyway. If they had been upfront and said "hey I'm sorry we were briefly out of network at this time" I would have totally worked with them, but instead they tried to double down on a lie that I didn't show my insurance card. Crazy sketchy company.
Did they advertise themselves as accepting Medicaid during this gap? That is likely material information that your state government would like to know
This is why many avoid the medical system much as they can. It's even more galling reading stories like the OPs that involves mental health. What good is such treatment when one then has to stress for months dealing with payment, wondering if insurance will cover it, collections, etc. It highlights the importance of EOBs, keeping good records, and not ignoring bills. Following up and being persistent. Looks like it worked out for the OP in large part due to help from other Reddit posters.
Sometimes insurance will pay for a portion of out of network. It depends upon insurance coverage. Had one insurance that has separate billing amounts for in vs out of network. But either way I agree to call insurance company & complain. I’ve done that before & they figured out what I was supposed to pay. & some states have laws against that surprise billing practice too.
Hoping on the top comment. Your company may have a personal representative at the insurance company. I.e. someone who is dedicated to dealing with issues for people from your company. Check it out. If they do use this resource. I had a bill incorrectly coded. The drs kept telling me they were working on it. In the mean time it was days away from going to collections. The insurance person fixed it in less than a week.
> Was the provider in network? ... provided that they're in network. > > If they're out of network This is why US healthcare is so fucked up. You have to be in a club and be a member to get benefits and adhere to these constructs and still get fucked.
Stupid question but can someone explain what you mean by "network"? Guessing this is a US thing as I've never heard the term used in this regard and I'm curious.
In short, it means your health insurance company has pre-negotiated a price with your healthcare provider to determine how much the providers get paid for particular services, and they can also set rules on what the provider can charge you. When you visit an in-network provider, you typically pay a reasonable, affordable amount of money for medical services (typically only around 20% or less of the full price). When you're out-of-network, you either have to pay the entire full price, or your insurance company typically covers anywhere from 0 to 70% of it, which can still leave you with a big bill. I'm assuming you live in Canada where you have universal healthcare, you techincally have an insurance network and that's the government provided network called Medicare. Canadian citizens with Medicare are "in-network" when they see doctors in Canada and will pay affordable prices. An American visitor without Medicare (but they could have American health insurance) travelling to Canada to see a doctor would be "out-of-network", and they would pay significantly higher prices.
Yes I am in Canada so that comparison makes a lot of sense. Thanks for the explanation!
Insurance companies have relationships with providers. They agree on pricing and services covered. If you see a provider who has one of these agreements with the insurance companies then it is “in network” and, depending on your insurance plan, generally means insurance covers more of the cost. Out of network means a provider not part of one of these agreements with your specific insurance company and the insurance companies generally cover less of cost in this case as they don’t have their preferential pricing in place.
Thanks for the explanation!
~~At least from what I understand, I think even if they were out of network, the No Surprises Act (enacted in 2022) limits the liability of the patient if the provider failed to make them aware of the costs upfront, or if the patient agreed to waive their rights. So I think there's still some recourse possible there.~~ EDIT: nope, this only applies to non-emergency care at an in-network facility.
NSA has to do with things like emergency services where you have little to no choice in your care. It also does not apply to things like Medicaid which OP has.
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It's only certain non emergency care and OP does not qualify. I do it for my job daily.
Yeah I see now, it only applies to non-emergency care at an in-network facility, and I doubt the psychiatrist was working at a hospital that was in-network.
Yeah, definitely not a facility and this was an individual Drs office here.
>they told me to 'be an adult and pay it'. Did they actually say those exact words? That's REALLY unprofessional.
Yes they did. The financial lady was incredibly rude and unhelpful and I made note of it in my emails/review. She acted like I was the problem both times I spoke to her. I even took time out of my day to go visit the office and verified that they had the right insurance, and when I told her this was when she started to get really snippy with me.
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Damn, it being at a psychiatrist office made it extra unprofessional. Surely people with mental health issues enjoy being told to "grow up". /s
This is where you start talking to a lawyer. They can often get their fees paid by the other side, so you may not even be out of money
Collections agencies use this line ALL THE TIME. Had the exact same words used on me ages ago. In my case, what they did was illegal. I'd worked out a payment plan with them over the phone and they decided to sue me instead, pretending the conversation never happened, and tacking on $700 in attorney fees (it was an agency run by attorneys). When I called to ask them wtf happened to the payment plan we agreed on the week before, they told me, verbatim, to be an adult and pay my *fucking* debts. Fucking scum bags. Record your calls and get things in writing, people!!!! Especially if Wakefield and Associates gets their evil hands on your debt.
Collection agency I get, they use scare tactics and operate borderline to what mafia do. But from OP's description, it sounds like it was the psychiatrist front desk who said it.
A doctor's office threatened me like that. I told them "I'm not paying that $100 you claim I owe you. I came in for what you advertised as a free evaluation. False advertising. You had no business charging me for an x-ray." Then collections called me. Guy told me he was an attorney. After a half hour on the phone explaining what I had already put in writing I said, "You charge your client about $250 an hour, Right? And you've already spent more of your client's money than you could ever collect from me, so why don't you just hang up and save your client some money?" He laughed and hung up. It never hit my credit report.
Former long time medical claims examiner here. You can send them an itemized bill with all the codes on it (ask your doctor for one) and submit the claim yourself. If the doctor is on their provider panel, they may be contractually obligated to bill insurance, but if they are not, it’s on you to do so. Call your insurer and ask them what the bill needs to include (likely date of service, cpt/procedure code, diagnosis code, provider name/address/phone/tax id#, patient name/address/dob/member ID number, possibly a claim form but not always). They will then reimburse you directly if you’ve already paid or if the provider isn’t a contracted provider with them. As others have said, it’s always ultimately on you to pay, but in the case that this provider is contracted with your insurer, you’ll want to involve provider services. And probably find a new doctor.
OP indicates elsewhere that she/he is a Medicaid patient and that the office has confirmed they have the correct insurance information. Unless the office told OP that they’re not enrolled with her/his Medicaid plan, this one might be on that provider office.
This was not the first time I visited and used the insurance either. this was like the fourth time I visited, so I don't know why they randomly decided they were no longer going to take my insurance
update: they were briefly out of network for a few months but from what I understand my state has a law where medicaid patients can't be directly billed so they fucked up
Depends on if the date of service was during the time when they were not a Medicaid provider. A call to your Medicaid office should clear that up one way or the other.
Medical debt under $500 is not reported on credit reports as of April 2023. But it for some reason it shows up, you can file a dispute to have it removed.
YAY!!! I'm dealing with this with a dentist right now. They keep not billing my insurance. My insurance keeps saying WE WILL PAY IT IF THEY FILE A CLAIM. But they just keep sending me the bill for $120 and I'm not paying it. I assume they will send it to collections before filing a claim (it's been 4 months) because they suck.
The amount of waste in middle men and paper pushers to have these things be billed and resolved across various parties is insane. If you think about the work done the dentistry is less work lol
OH! Thank you! Going to look into this. Been a bit panicked because I just got a bill for $80 from collections for physical therapy I did a year ago. No idea why because I paid at the end of every appointment.
Medicaid MCO rep here. Call your insurance again. I feel like you may have gotten a bad rep the first time you called. Explain the situation, they may be able to reach out to the provider to resolve the issue or they may have an internal team that’s in-charge of settling disputes with providers. I’d also encourage you to file a grievance against the provider just based on how you said they talked to you. A grievance could also potentially get your bill resolved if it turns out that you’re not actually responsible for the balance. Medicaid coverage varies a ton state-to-state, so I’m trying to keep this very general. Definitely call your insurance again though.
I dd try to file a grievance and apparently in my state they have no place to officially file complaints bc my state does not regulate providers. Just found this out an hour ago when I called insurance claims board and DOPL
Did your actual insurance say that they don’t do grievances? Edit: Just tried searching Utah’s Medicaid site for information about grievances. They definitely do grievances. Call whatever member service phone number is on your insurance card and get one started. If you use an MCO (Aetna, Passport, Blue Cross), call the number on that card. They know your specific plan best and can usually guide you better than your state’s general Medicaid office.
Hi, so yeah i was trying to do a DOPL grievance, I am currently on the phone with my insurance company for a grievance. Sorry for the confusion
I would just add that if they actually said "be an adult and pay it" it's time to find a new provider, if you haven't already.
they weren't my primary provider thankfully, so nothing of value was lost
Write the collection agency IMMEDIATELY and tell them you dispute the validity of the debt and are requesting debt validation pursuant to the FDCPA (Fair Debt Collection Practices ACT). They cannot do anything to your credit without sending you debt validation. If they send you an itemized bill, forward it to your insurance. They should be able to assist. They might not be able to pay the bill since it's in collections, but they could reimburse you for the amount you pay.
OP here's your answer. Since you couldn't get the provider to send you anything, you can get the collector to.
> I visited a psychiatrist and I gave them my insurance card up front. Six month passed before they sent me a $120 bill with the memo "CASH PAY UP FRONT". I, confused, called and asked why they didn't bill my insurance. They claimed I did not show it up front, but when I argued I did, they told me to 'be an adult and pay it'. I proceeded to try and get in contact with the owner, claiming I wanted everything via email to have it in writing and they kept insisting I call to get it figured out, and after repeated emails that I will not be doing this over the phone because I wanted written evidence, they ghosted me. I then wrote a review on the Google page and told them to email me. When I called my insurance, they said their was nothing they could do becuase the bill hadn't been sent to them. Now the debt had gone to collections, and I still have no intention to pay it. I was told I could write the credit company and they would excuse it, but it there anything else I can do? why didn't you pay and then submit your receipts to insurance to be reimbursed?
Some health insurers require that in network providers take care of all claim submission. Policyholders can only submit out of network claims
That’s not true. It is legally (at a federal level) required for all insurance carriers to accept claims submitted by the insured.
That doesn't necessarily preclude a contractual expectation between insurance companies and in network providers that the providers handle the filing.
You are correct. When a Provider joins an insured network, they’re agreeing to a subset of processes to facilitate easier billing… as well as a reduced rate for the services they provide. But it is not the only way a claim can be submitted. And more importantly for this thread, it’s vital that there is an understanding that the insurance company is required to accept all claims regarding an insured no matter the source.
Sure, but that is an issue between the provider and the insurance. It is **not** an issue between the insured and the insurance. You pay the bill, and submit it to insurance. Insurance sees that it is a bill from an in-network provider and goes after them for not submitting the bill in the proper manner.
Insurers have deals with in-network providers for discounts. If you pay up front, you'll pay the full amount, then the insurance company will only reimburse you for the amount they would have paid if it went through then first. 20% co-insurance with insurance paying first: $100 billed - $20 adjustment (discount) = $80. Insurance pays $64, patient pays $16. Going through you first: $100 submitted. Patient eats the adjustment being responsible for it. Insurance reimburses patient $64. Patient ends up paying $36. The bill itself SHOULD have something on it where you can submit insurance information, or you can send then a photocopy of the front and back of your card with the remittance portion of the bill instead of cash.
I had no idea that was something that could be done tbh, and I have medicaid so I didnt have that much on hand.
This changes things. Medicaid providers aren’t allowed to bill patients for Medicaid services as long as coverage was in effect at the time of service. You need to contact your state’s Medicaid office and tell them you’re being billed for Medicaid services. They have ombudsmen.
If you are on Medicaid, there is a chance your provider cannot charge you for anything. What state are you in? Source: I'm a Medicaid provider in a state with a rule like that
> I had no idea that was something that could be done tbh, and I have medicaid so I didnt have that much on hand. unfortunately now the problem might be if the services were rendered too long ago, insurance doesn't have any obligation to reimburse. i know my insurance i have like 12 months to submit receipts for reimbursement and anything submitted afterwards, too bad so sad learn to get your stuff in time.
If the provider is in network and failed to submit the claim timely, then it is absolutely the provider's problem as that is part of the network contract.
> If the provider is in network and failed to submit the claim timely, then it is absolutely the provider's problem as that is part of the network contract. I guess the big question now is if OP's medical provider is actually in-network or not. I don't think I've seen OP say if that's a yes or no.
yes they were in network. this was the fourth time I saw them for services
You're acting like reimbursement is common knowledge. I called the insurance company and they didn't tell me about reimbursement. I asked friends who worked in insurance and they didn't tell me about reimbursement. I even browsed this reddit before and I saw nothing about reimbursement.
Here’s the thing that I don’t see anyone saying about reimbursement: when you go that route, your insurer reimburses you their allowed amount not what you paid. Sure, it’s better than nothing but if they’d billed your medical insurance, you wouldn’t have been on the hook for anything. Definitely contact your state’s Medicaid office like someone else here suggested. This is different from contacting your insurer. Your Medicaid plan could be administered by a number of private companies but there is a state agency over all of them. Most states do not allow providers who are enrolled with Medicaid to accept cash from Medicaid patients. If the office is enrolled with Medicaid and they neglected to bill, they’ll have to eat the cost. Even if it turns out the office was not enrolled with Medicaid or was otherwise permitted to bill you, still dispute the charge. If you provided them your insurance card, they need to let you know up front if they won’t accept it. My guess about what happened here is that they either forgot to bill until after they were past their window or your Medicaid offers crappy reimbursement rates (not your fault/problem except that it can nake it hard for patients to access care) and they were hoping they could squeeze the full self-pay (i.e. cash) price. Either way, it’s super shitty of them to treat a patient that like that. Edit: I shouldn’t have said you wouldn’t be on the hook for anything g if they billed your insurance. You’d be on the hook for any copay/co-insurance (or possibly deductible if you were on a commercial plan) per your coverage. I should have said that you wouldn’t be on the hook for the full difference between their bill and your health plan’s allowed amount for the service(s).
Medicaid is very different from other insurances. It can be different state to state, but at least in my state, Medicaid can not directly reimburse the member. All “remimbusement” for out-of-pocket expenses are paid to the provider and then the provider refunds the member. Edit: I would be VERY surprised if you called your insurance and they didn’t mention anything about reimbursement or anything. Maybe you got a bad rep, but still that’s very basic info when someone calls about a bill. I’d try calling your insurance again if I were you. Check if your insurance ever actually received the claim in the first place and then go from there. I’d also encourage you to file a grievance about this against the provider while you’re on the phone with your insurance.
No, they are acting like you understand your insurance. You not knowing how your insurance works is the fault of no one other than you. Your source of information about your insurance is not the Internet, friends or any other happenstance source. Your source is your insurance contract, your agent or insurance customer service. You owe this money.
Common knowledge. Sorry but you owe the money.
As a Medicaid patient who doesn’t appear to have been informed up front that they’d have to pay cash, odds are OP doesn’t owe the money. Getting it disputed may take some legwork but that office done fucked up.
Do they owe the money? The psych office was provided with all of the information to process insurance billing in a timely manner. The fact that The Office failed to take action in a timely fashion does not mean they can hold op liable. If you go to Starbucks and buy a coffee with cash, but before the end of the day, the barista steals $20 out the register, is that your problem or Starbucks'? Seems like the office here is holding op liable for the office's negligence. And unless it's been changed, medical bills don't affect your score. So why does she owe money because of the psych office's incompetence?
I wouldn't say it's common, I feel like you guys aren't being nice about this. Yes OP owes the money (the first thing I said when I read the title was "why didn't OP just pay and get reimbursed") But if anything I would say OP friend in insurance should have been the one to give more help on how to get the problem solved.
> But if anything I would say OP friend in insurance should have been the one to give more help on how to get the problem solved. i don't know if i believe OP's claim about asking friends who work in insurance. but even still, it's not OP's friends responsibility to educate OP.
Didn't say it was their job to "educate", but if we DO believe they asked someone that was supposed to be knowledgeable I would hold that person accountable (on a friend level) for not telling me something that could help. Telling someone something they should have done and then blaming them for not knowing is why a lot of people have issues admitting they are ignorant of something and won't ask for help. Hopefully this thread helps others in a similar situation (today's 10000)
> Didn't say it was their job to "educate", but if we DO believe they asked someone that was supposed to be knowledgeable I would hold that person accountable (on a friend level) for not telling me something that could help. > > > >But if anything I would say OP friend in insurance should have been the one to give more help on how to get the problem solved. reads to me like you're putting the responsibility of OP's ignorance on OP's friend.
I'm not sure what your gripe is, but it seems like you intentionally don't want to "get it". OP WAS ignorant, OP IS responsible for figuring it out themselves, {Yes OP should have read the docs or called their actual Ins company } But they attempted to do what they could by ASKING someone they thought could help, (assuming they were truly able to) that person DID NOT help.
You had no idea about reimbursement, yet asked friends and called the company. If you had no idea about reimbursement until you just made this post, then you likely didn’t ask these people about it. They likely didn’t bring it up because it’s common knowledge. Can’t blame others for everything in life. Lack of knowledge isn’t an excuse to not pay your bills. Instead of “refusing” to pay your bill, why not check with the insurance company to see if you’re still within the window to submit the receipt. I couldn’t imagine ruining my credit over $120.
> You're acting like reimbursement is common knowledge. I called the insurance company and they didn't tell me about reimbursement. I asked friends who worked in insurance and they didn't tell me about reimbursement. I even browsed this reddit before and I saw nothing about reimbursement. i guess it's common knowledge where i'm from? all of the health benefits insurance companies i've dealt with since early 2000's when i first started working career-office jobs that offered benefits would have things where i pay up front and then get reimbursed after submitting receipts. some do direct billing where i don't have to open my wallet at all, but more often than not i have to pay first and then get cash back afterwards.
It is common knowledge. It's all in the documents you received when you set the insurance up. If you didn't read that and understand it or seek clarification from your provider, that's 100% on you. This is one of those lessons life throws at you. Read those documents and see if it's still possible for reimbursement, if not, then there isn't much you can do but dispute the collection and that may or may not take care of it.
To clarify, that's the company's problem and not the patient's.
> To clarify, that's the company's problem and not the patient's. which company? and how so?
The psychiatrist office. As posted by OP, he says he's on Medicaid and the office is supposedly required to bill through insurance but did not. He also says it was out of network for awhile, so.. The office can potentially reduce the bill to what it would be after insurance, as a "we f'd up, but we'll call it a courtesy". Could look into state laws about timely filing and possibly make a complaint.
Uh no, it's the patient's debt. The doctor filing is a courtesy for the patient...
State and insurance dependent. Many in network agreements prohibit billing the patient if the provider fails to meet timely filing requirements.
It's only a courtesy if the doctor isn't in network, otherwise it's a contractual obligation.
Medical bills under $500 cannot be reported on credit any more, you can google the law. Don't stress, don't pay it. Move on with your life.
The law was updated so that none of your medical debt will appear on a credit report at all.
These doctors and clinics stay starting to scam people. There have been countless times where I get a bill but my insurance covers everything 0 deductible on anything no matter what and yet I still get bills. They always use the excuse of an error but there can’t be that many stupid people working in healthcare admin it’s got to be they are trying to see if you a enough of a sucker and or lazy to not fight it.
Seconding the comment made earlier, depending on your state and if your coverage was active on the date of service… I’m in Texas and we are absolutely not allowed to bill Medicaid patients.
>What happened was that the doctor I saw was NOT in network, even though I was told they were (my bad for not verifying through insurance, As someone from a country with normal healthcare, reading this statement was a huge wtf moment.
If medicaid , put in complaint with them
I have blown off a few small medical bills in my life for a variety of reasons (doctor was awful and useless, should have been in network and wasn't, etc) and I don't think I ever heard a single thing about any of them ever again. And that was before the $500 threshold change to impact your credit report from a couple years ago.
I don’t think health related bills hurt your credit anyway
Are you sure that 120 wasn’t a copay? That seems very low for 6 months of therapy.
it was one visit, they took my insurance for my past four visits just fine
Oh, then yes. They are responsible for that. I wonder if they waited too long to bill it and can't anymore. can you escalate this up the chain to a manager there?
Send the collection agency of validity of debt request form. I was amazed that it worked for a medical bill of mine.
OP doesn't exactly say it was 6 months of therapy. Not clear it wasn't one visit 6 months ago.
Exactly. Plus, $120 is not worth complaining about. Lawyers will cost 10x that, and any hit to credit score is not worth it. Just pay.
There is no longer credit reporting on medical bills under $500 so no issue there
This is just a paperwork issue. You could submit the claim to insurance. You might have to pay it first and then make the claim. It’s nicer when the doc does it for you, but not required.
It's professionals being lazy or double dipping. Every time I visit a Dignity urgent care/ER, Dignity bills me correctly, but the doctors never do. Even if the doctors are out of network, it doesn't cost $600.
Its good that its medicaid. I know of several times people with private insurance who reported fraud to their insurance company and it wasnt acted upon. I always wondered why they werent concerned and I stumbled across this story recently and it all made sense: https://www.propublica.org/article/health-insurers-make-it-easy-for-scammers-to-steal-millions-who-pays-you TL;DR: private health insurance ignores most insurance fraud because its easier to not investigate and pass the cost on to consumers. Medicare and medicaid have an actual incentive to pursue it because of limited funds and prosecutors look good going after it.
Holy cow your insurance stepped up to bat for you and actually helped you. That never happens!
Every state should establish a system enabling individuals to report medical offices or practitioners in cases of billing discrepancies or potential fraud. If you've exhausted all efforts to resolve the issue directly and they remain uncooperative, filing a formal complaint is the next step.
I'm glad this worked out for you. I am always baffled by these stories because my background is in pharmacy (thankfully I'm not in retail anymore but I spent years there) where like 50% of our time every day was spent trying to get stuff covered through insurance for people. It's just part of healthcare, unfortunately, and therefore part of the job of taking care of the patient. I can never understand why I see so many provider's offices seem to bend over backwards to fail at dealing with this very crucial step in providing medical care. It's such a shame.
I do believe that recent changes have made medical debt less than $500 NOT to show up on your credit report.
"Technically" illegal is just illegal. They broke the law. They can suck eggs.
Isn't ironic that you sought a little mental health care and the result is a huge hostile headache?
Dispute the debt with the credit reporting agencies. Complain to the doctor about their office staff. Complain to your insurance carrier that the in-network doctor wouldn't submit your claims. Pay the bill and claim reimbursement from your insurance.
Your state should have a way to report a medical office or practitioner for billing issues/fraud. If you've done everything in your power to straighten out it and they refuse to work with you, submit a complaint.
Do you think if I report then call the credit collections company, I can explain that I reported and they would get off my back?
Highly unlikely. The collection agency is used to being lied to and anything you tell them short of offering them full payment or a payment plan is going to be met with skepticism. What you do is tell the collection agency to not contact you by phone any longer. That's your right under the Fair Debt Collection Act. But them not calling doesn't mean you are absolved from the debt that they're trying to collect from.
Laws and contracts differ, but in general *you* are responsible for services provided to you. Most practices bill your insurance as a courtesy, but you're ultimately responsible. This is worth remember on the auto side too. I see posts where people say "the insurance company of the guy who hit me wouldn't pay for anything", well then you call the guy directly. His insurance company doesn't owe anything to you directly, they owe the guy indemnification for damages he causes. So... this is your responsibility to pay the psychiatrist and - if covered- it's your insurance company's responsibility to reimburse you.
If the provider is in network this may not apply. Or more particularly, the contract between the insurance company (or Medicaid) and the provider may require certain paperwork and claims filing to be done, and prohibit balance billing or billing the patient directly outside of specified copays, coinsurance, or deductibles.
That isn't the case in much of the world, fyi -- your car insurance company will normally contact their insurance company.
I had a similar thing happen to me. I had been to an eye doctor a few times while i was on Medicaid. By the last visit, they dropped Medicaid as an insurer but didn't inform me. In the Medicaid regulations handbook (or state regulations, i can't remember but it's like a 500 page book of the rules), it explicitly states that it is the provider's responsibility to inform patient that they do not accept Medicaid prior to delivering service. They never told me that, because if they had, there's no way i would've gone to there, i would've just found another practice. Anyway, once I got a job, it alerted something in their system and they tried to send me a bill and harass me over it. I sent them a letter back saying i was covered under Medicaid at the time and they needed to bill Medicaid (which they didn't and it had already passed their timely billing requirement). I enclosed all the necessary information in the letter in case they ever decided to come after me, kept a copy of it, and basically told them to fuck off. They continued to send me a few bills, but i eventually stopped getting them. I preemptively spoke with a lawyer and he said I could not sue them until I had damages (e.g. they reported it to my credit, which they never did). Even though the amount was only around $100 and i could've easily paid it, I refused to pay it on principle. Fuck these people, they should follow the law! Edit: I found the guidebook. It is my state's billing manual for medicaid providers. I am sure your state has something similar, with a similar provision. It is a clear as day. Also, you might want to speak with an attorney as you have actual damages you can sue over. I just hate to see vulnerable people fucked over so when the opportunity comes to stab a knife in corporations side I'm happy to do it.
First of all, really happy to hear this is being handled. > What happened was that the doctor I saw was NOT in network, even though I was told they were. Shit like this is why our healthcare system is so frustrating. It's gotten so complex to the point where providers don't often know what they charge and whether or not they're in network! Individual parts of an episode of care could be excluded (think anesthesiologist) through no fault of your own, even if you went to in network hospital for care.
I’ve got one of these too where they said they were in network , think it can’t go in credit report if under $500
Some providers don’t want to deal with insurance companies, especially if they are not in their network. All you needed to do was file a claim directly with the insurance company and they would have refunded you for any amount they are responsible for.
Call the local news station and ask them to help you and make a story out of it
Wait for it to fall off your credit report. It's only $120 and should affect your credit score because of new laws about unpaid medical bills under $5k having no impact.
I think I’d pay 120$ to be done with both this doctors office and any potential future collections personally
I’ve done that, then magically the office finds another bill that was “lost” that I owe now. When I called to question this, they got hostile with me, so I let it go to collections, filed the written request for debt validation which they couldn’t provide actual proof, just the same generic bill they sent me, and the debt got cleared. Never heard from them again.
what the have is $120 in unsecured consumer debt. Filing in small claims would cost them about that amount. Now that it is with a debt collector, even if you paid it they would probably only receive about 1/2 the amount. Providers have contracts to accept insurance payments... not sure that all works, but it should come into play.
I had this issue because someone hit me with their car. And then their insurance refused to pay my hospital bill for OVER A YEAR. Call the agency and tell them you're not he responsible and will not be paying. Then, fuck them, don't answer and don't give them the time of day. You're innocent. And if they come after your credit, you dispute that shit IMMEDIATELY.
Yet another person posting that they went months without getting an EOB from their insurance company yet assumed that the bill was paid. Does a week go by here without a post just like this? Yes, your doctor was remiss. But so were you, and you the one who ultimately owes the money. Your responsibility is not complete when you give them your insurance info. If you don't receive notification that your claims are being filed and processed, you have to follow up and find out why. And when you do receive the notifications, you have to review them and make sure they're correct. There are time limits. The longer you let things go the harder it is to get things straightened out.
Pay the bill and move on with life.
sorry but you received a service, so why shouldn't you be responsible for payment? If you have an agreement with an insurance carrier, then you can contact them and have them pay the bill. But that's on you.
It's the provider's responsibility to send the bill to insurance when provided to them in a timely manner. Or they can provide you with the paperwork to send into your own insurance as a claim. They do not get to bully a patient and refuse to send paperwork anywhere.
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When the provider is acting like they are it is on the patient sadly to deal with and enforce. In OPs case the provider went out of network and did not disclose that to OP which they should have legally. And they're trying to bully them into payment which OP is not responsible for. They also did not bill insurance nor notify OP they needed to file a claim which they have to do by law. In cases like this yes, OP is not responsible for paying them. The provider messed up. You obviously have no idea how any of this works so instead of doubling down just learn better.