Author Topic: Billing question  (Read 2208 times)

F8ke1

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Billing question
« on: May 06, 2013, 10:47:30 PM »
My orthodontist sent me a bill that only says my insurance won't cover all of the agreed upon amount for the work preformed. I signed an agreement that I would pay any amount that the insurance didn't cover. I called my insurance company to find out the reason why this amount ( 300 dollars) wasn't being covered. My insurance told me no claims have been denied and to get back with my doctor to see why he hasn't sent in a claim for the amount do ( and by the way the amount I was billed for matches the amount left in this insurance account ( don't know if that helps)). I went back to the doctors office and all they will say to me is that I signed a contract with them and need to pay them now and can they set up a payment arrangement with them today.
     The long and short of it is they won't their money and my insurance can't say why they haven't made a claim for the last bit that they have shown that they know how to get. Should I pay them?

RichardP

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Re: Billing question
« Reply #1 on: May 07, 2013, 12:05:29 AM »
If you carefully examine what you signed, you may discover that you agreed to be responsible for the entire bill.  That is consistently what the agreement says for all of our clients.  The doctor may agree to accept insurance monies, as a courtesy to you his patient.  Or the doctor may agree to bill your insurance for you, as a courtesy to you his patient.  But some doctors put it all on the patient - they expect 100% payment from the patient, and it is the patient's responsibility to bill his own insurance company for whatever monies they may send to the patient.  Perhaps you have encountered one of these doctors?

Hint:  if your doctor is a participating provider with your insurance carrier, he is bound by his contract with them.  If he is not a participating provider, he can require anything from you that your state does not forbid.

PMRNC

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Re: Billing question
« Reply #2 on: May 07, 2013, 09:09:36 AM »
MOST orthodontia plans only cover $2000-$3000 and I can tell you the cost of care/braces is way over that.. I don't want to assume to know the plan coverage rate or the particulars but if your only being billed for $300.. this is just a guess but you got off pretty good. I know people coming out of pocket a few grand AFTER the orthodontia coverage.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

F8ke1

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Re: Billing question
« Reply #3 on: May 08, 2013, 12:18:47 AM »
Thank you for the replies! Yes ik I got off easy at this point. Guess I'm just upset. Why pay for insurance when your provider won't bill your insurance. I will bite the bullet tomorrow and cough it up for them. Score: 1296 insurance , 4804 home team!

RichardP

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Re: Billing question
« Reply #4 on: May 08, 2013, 10:38:07 AM »
Why pay for insurance when your provider won't bill your insurance.

Answer:  If you have no health insurance, your provider can charge you whatever he wants to and you have no one to intervene for you.  If you have health insurance, and if your provider is a participating provider with your insurance company, his contract with that insurance company limits what he can charge you.

Even if you think your health insurance coverage is crappy, if you see a provider who participates with your insurance company, you will usually end up paying less money than if you had no insurance at all.

PMRNC

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Re: Billing question
« Reply #5 on: May 08, 2013, 01:58:47 PM »
This is Orthodontia... completely diff beast.. VERY cut and dry in benefits with a max benefit.  Probably the easiest claims to bill.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

timothyhadl

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Re: Billing question
« Reply #6 on: June 03, 2013, 07:01:28 AM »
What are the factors one must consider while getting a health insurance to ensure maximum benefits and avoid such circumstances?
_______________________________
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PMRNC

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Re: Billing question
« Reply #7 on: June 03, 2013, 06:18:11 PM »
Quote
What are the factors one must consider while getting a health insurance to ensure maximum benefits and avoid such circumstances?

NONE. Orthodontia is a different coverage and NOT considered a major medical benefit, nor is it an offered plan/service in the ACA.  THE best policy you will find is $3000 a year and normally only employer sponsored plans will offer it.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com