Dr. is trying to rip us off - Big Big Forums

Johnsmom · 06-15-2003, 10:55 PM

I have an HMO. Hubby went to an oral surgeon to get his 5th (yes 5th

) wisdom tooth removed. To make a very long story short, we paid more than our copay since the dr's office insisted. We got most of our overpayment back from the HMO, but the Dr is still billing us (it has been 6 weeks) and sent a nasty note here on Saturday. Our EOB from the HMO says we should have only paid $25.00. Right now we are out $50.00 (originally we paid $291.00). I have called the HMO several times to get them to contact the Dr. They have called but the b**** who answers the phone just does some song and dance about how they can charge us all these co-pays per their contract (they can't). Also, I have had repeated conversations with the office woman up to the day of the surgery with no luck. HMO knows something is up w/the Dr as they are investigating him and this is happening to other poilicy holders with this dr. ANyway, this has ruined my weekend!! Hubby is gone with the Guard, my kids are sick, and this Dr's office keeps harassing me for $$ I do not owe. I will be calling the HMO tomorrow as well as the BBB and Attorney General. (possibly the Dental Board). My fear is that all these agencies will take too long and this dr will turn me over to collections and wreck my credit. The dr sent a little note on a print out telling us they can no longer carry our account. I hope these ramblings made sense so that maybe someone can give me some advice. Any ideas or advice would be helpful. TIA

This Dr. is really ticking me off!!!

I have so much anxiety and I can't stop thinking about this. I know I won't sleep much tonight worrying about this and all the calls I will be making tomorrow.

edited to add: my last 2 calls to the HMO to deal with this were never followed-through by the reps who took the calls. They were supposed to tell the Dr they can't be balance billing me, but the elusive ball was dropped.

1busymomma · 06-15-2003, 11:48 PM

This happened to me, I just stuck to my guns, became somewhat nasty and they took care of it. Did not ruin my credit at all. (((((((((((((hugs)))))))))))

twinkiesmom · 06-15-2003, 11:58 PM

Does your HMO send u the Explanation of Benefits? What was actually paid to the Dr. I keep mine religiously. Drs, Labs, etc have tried to bill us for the extra they didn't get from the insurance. They are contracted w/the ins. They are supposed to accept what the ins pays em. That is their negotiated rate. The Explanation of Benefits paper shows that rate. It also shows the amt that the ins didn't pay because the Dr. signed a contract to accept that amt. If it looks like you are being billed for this amt., I'd be raisin hell too! Good luck.

Johnsmom · 06-16-2003, 12:01 AM

Thanks for responding. So far, even nasty hasn't worked-but I can get nastier still. Truthfully, I think this Dr's office is into a bit o' fraud. They overcharge their patients by saying you have to pay all these different co-pays when you only owe one. I only have any written verification of what I owe because the insurance company reimbursed me some of my overpayment because I sent them my receipts. There was an EOB attached to the check. Otherwise, the HMO doesn't ever send you an EOB and if you weren't up on these matters, you may never know you overpaid. My hubby wouldn't have known. Anyway, sorry to ramble again, Thanks for the encouragement. I have the feeling I will be on the phone all day tomorrow about this. Wish me luck.

twinkiesmom · 06-16-2003, 12:12 AM

Yeah, stick to your guns. I always tell my Drs to just bill me after the ins pays . . . The ins does pay 85% . . . but chances are if it's beginning of the year, I owe more to Dr anyway cuz copays/out of pockets n stuff hafta be met. I never give the Drs ofc cash at time of services. If they have a sign saying pmt is due . . . I tell them to bill me after ins. They don't like it . . . they don't need my acct. There are other docs out there. Hope u get it resolved.

Johnsmom · 06-16-2003, 12:13 AM

Quote:

Originally posted by twinkiesmom
Does your HMO send u the Explanation of Benefits? What was actually paid to the Dr. I keep mine religiously. Drs, Labs, etc have tried to bill us for the extra they didn't get from the insurance. They are contracted w/the ins. They are supposed to accept what the ins pays em. That is their negotiated rate. The Explanation of Benefits paper shows that rate. It also shows the amt that the ins didn't pay because the Dr. signed a contract to accept that amt. If it looks like you are being billed for this amt., I'd be raisin hell too! Good luck.

This is exactly what they are doing. The whole thing is just what you said, they are really trying to charge me the negotiated discount. The HMO has verified with me during several calls that I only owe $25.00 and the rest is write-off. The Dr's office staunchly refuses to do this, claiming they can charge me more because they have a "special" contract with Aetna. I guess this contract is really special because even the provider relations people who were looking at the contract couldn't find this "special" provision. It must also be invisible LOL. The provider is under investigation with Aetna, but I am really concerned that the Dr is going to send me to collections and harass me even though the HMO says I don't owe the money. So far, the Dr. has completely disregarded anything the Ins co tells them. This is unreal. I worked in Health Ins for 10 years before I had children and I never had a provider refuse to write off something once I called them for a customer. I even worked with fraud and other legal matters concerning health insurance-and this Dr is still one of the worst I have ever seen.

twinkiesmom · 06-16-2003, 12:17 AM

No. That's bs. They can't take u to collections. Keep your EOBs. Don't throw em out. They send u a bill, copy that eob n send it back w/the amt Not Payable circled. Sounds like he has a special contract w/the fraud dept. LOL

Johnsmom · 06-16-2003, 12:25 AM

Quote:

Originally posted by twinkiesmom
No. That's bs. They can't take u to collections. Keep your EOBs. Don't throw em out. They send u a bill, copy that eob n send it back w/the amt Not Payable circled. Sounds like he has a special contract w/the fraud dept. LOL

A-ha, so that's where that special contract is!!!!!!!!!!

I am so anal-I made 5 copies of the EOBs

twinkiesmom · 06-16-2003, 12:29 AM

Even if they do have the balls to go to Collection Agency . . . I'd be sending a copy of that EOB to Collections if u get anything. If they are charging u more cuz of some special crap . . . chances are they're not billing correctly. S'no wonder they're being investigated.

justme23 · 06-16-2003, 12:31 AM

I have Aetna dental insurance. My husband went in a month ago to have 2 teeth pulled. We payed just over 100 dollars (we pay 20% as opposed to a $25 copay). Well I got a letter from my insurance showing what they payed and what I should have payed... it was sixty dollars less than what we payed. I promptly got on the phone and called the OS (he's like the nicest guy in the world and so is his staff). Well first I was appalled to find out that insurance companies actually only pay them half of what they ask for (and you have to pay the 20% of what they WANT to be payed upfront and they are SUPPOSED to refund it after they find out what the insurance will pay)... but I was told that patients get the explanation of payments before the doctors do and that they will send me a check if infact I was correct. Well I knew I was, I had the paper right in front of me! And Friday we got our sixty dollar check in the mail... so your OS is just a pos and fight it until the very end... call whoever you have to to get this taken care of! I can almost imagine most of his patients calling to fight this and giving up after they get the run around... don't be one of those ppl, get your money back!

Johnsmom · 06-16-2003, 12:43 AM

I thought about giving in as I have spent hours and hours on this, but I won't. This is over $200.00 and that is alot of $$ to me. Think of how many surveys that is LOL. I will keep on fighting. You guys are making me feel better about this. I felt so alone-like I just couldn't make anyone take care of this-but I will. If nothing else, I will take up so much of their time with complaints to the BBB etc they will finally give up. Never try to screw a freebie hunter out of money!!!!!!