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What do you do if you receive a bill from your doctor for services that you think should have been paid for by your insurance company? What if your doctor states that your insurance company has denied payment, so you are liable. What if it's hundreds of dollars? What if it's for an old date of service? Do you pay the bill?
Well, maybe, but certainly not without checking into a couple of things!
The first thing you will want to do is to call your doctor's office and find out exactly what you are being billed for and why. Sometimes the bill will indicate exactly what services the bill is for, but it does not hurt to make sure. If you have insurance that you feel should have paid for the services, ask the doctor's office why they did not pay. They may have not billed your insurance correctly. Verify the insurance company and the id # 's that they used. Also, verify that the service they billed for was the actual service you received. For example, did they bill for a routine check up when you were actually there for a medical reason? Some insurances do not pay for routine check ups. Many times a call to the doctor's office will clear up the matter. Based on information from your phone call, the doctor's office will be able to go back and rebill your insurance for payment.
If your phone call the doctor's office did not clear up the matter, but you still feel that your insurance should have covered the charges, call your insurance company. The phone number is usually on the back of your id card. Ask them to explain to you why the charges were denied. If the charges were denied, and the customer service representative tells you that the denial is correct, ask them if you are responsible for the charges. In some cases doctors are contracted with insurance companies and they can not always bill the patient for charges that are not covered. Do not assume that the person doing the doctor's billing knows if they can or can not bill you. Many offices have people in charge of the billing that do not understand all of the insurance guidelines.
An example of a situation where the doctor can not bill you for the services is if the charges were denied for timely filing. Some insurance companies require that a doctor submit the insurance claim to them within a specific time period, for example, within 90 days of the date of service. It is in the contract that the doctor signs, and it states that if the doctor does not submit the claim in that time period, the claim will be denied and the doctor CAN NOT bill the patient. I have seen many cases where the doctor's office attempts to collect the money from the patient. However it is not the patient's fault that the doctor's staff did not submit the claim on time. The patient goes to the provider knowing that the provider accepts their insurance and expecting the doctor to be paid by the insurance company.
Many times the services can be reprocessed by the insurance company simply based on information that they receive from you during your phone call. Sometimes services are simply denied due to human error on the part of the insurance company. Or since so many things are automated, the denial may be due to a computer glitch. In any case, it is well worth the phone call to determine if the charges can be paid.
There are obviously many other reasons that the services may have been denied by the insurance company. I can not possibly cover them all in one article. In some cases the services are denied simply because the particular service is not covered under your plan. If it turns out that the claim was denied correctly, and you are responsible for paying your doctor, you should try to make arrangements with the office regarding your payment.
If the amount due is larger than you can pay at one time, ask if it is OK to make payments. Also, it is OK to ask if they will discount the bill, since it is not covered by your insurance. They may not, but you will not know if you do not ask.
Do not just pay a bill because you receive it. Unless you know for sure that you are responsible for the amount you are being billed, you should always check into it.
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Source by Michele Redmond
