Payments > Patient Billing

copay refunds

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PMRNC:
Definitely sounds WRONG to me. Start by making formal request for all EOB's for that provider. Put your request in writing and send it certified mail.
Do same with the podiatrist. Request an itemized statement (or ask for patient audit record) for ALL patient history/visits. AT very least you will put them on notice.

Your refund is going to come from the doctor. You already know that..but the key to doing this is to alert the insurance carrier AND the doctor and let them know you are on to them. You could be pleasantly surprised to find a check in the mail shortly... <g>

DO both these requests CERTIFIED RETURN RECEIPT .. :) 

dekenn:
Thanks, Linda!
I actually spoke with the billing person at the doctor's office.... she knows I'm on to her, and honestly, I did expect a prompt response. I've already told her, via voice message (she won't return phone calls) that my next step is to contact the fraud department.... still no response...I'm thinking maybe the doctor doesn't know what's going on???

Will send out the letters as you suggested.... thanks again!

PMRNC:
Always smart to ask them for a patient "AUDIT of ACCOUNTS" The word "audit" should make them stand up straight. :)

RichardP:

--- Quote from: PMRNC on June 08, 2015, 04:10:38 PM ---... formal request for all EOB's for that provider.
--- End quote ---

By all EOB's I assume you mean all EOB's for the patient in question for that provider?

kristin:
As the office manager and biller for a podiatry office, what this office is doing really ticks me off.  >:(

I mean, c'mon...you run an A/R report every month, and you can clearly see if there has been an overpayment on an account, and you figure out why, and who needs to be refunded, either patient or insurance. This isn't rocket science. So they had to know month after month that there was a credit on your grandmother's account, and they just ignored it, or worse, did an adjustment in her account to make the credit not show up.

I also think it is a load of BS that it would take a LONG time to research this...EOB's are financial records, and should be kept on file for seven years, at the minimum. I don't care in what format, be it paper, or scanned onto disc, or whatever. I could find EOB's on four years worth of visits for one patient in less than an hour in my office. So they are stonewalling you with that lame excuse.

Finally, I can't tell you how many patients we get in a year with Medicare or MA plans, that clearly meet the requirements for having their nails debrided, but that have been seeing various podiatrists who have made them pay $50-60 cash to have the service done. Because the office/doctor told them "this isn't a covered service with Medicare". Which means either the office/doctor clearly do not understand what is considered a covered service with Medicare, or they do, and they just flat-out lie to the patient to make them pay more with their cash payment then they would receive from Medicare.

So what I would do in terms of what they told your grandmother about charging her is call Medicare and the OIG. And I most definitely would get her another podiatrist, and vet the office beforehand for her.

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