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9/22/2017 12:11:25 AM
Posted: 8/15/2005 2:19:02 PM EDT
[Last Edit: 8/15/2005 3:30:28 PM EDT by Dolomite]
My story: Go in to be evaluated by a big time Orthopaedic for Plantar Fasciitis (heel spurs to you and me).

They don’t take my cheap-O insurance – they tell me that right off the bat – but they copy my insurance card and driver’s license anyway. They make me sign a waiver stating that I realize since they don’t take my insurance, I’ll be responsible for paying for services that day – fine.

The visit ends and I owe them $435 – I cut them a check, grab all the receipts I need to fill out a claim, and leave. I immediately send off the claim to my insurance company and anxiously await my reimbursement.

A few weeks go buy – according to my insurance company’s web site my claim has been “voided” and a check has been sent to my doctor’s office out of my Health Savings Account instead of me.

Why was a check sent to the Dr’s office? Because they submitted a claim to my insurance company after they took my money! Now – is that or is it not double dipping?

Anyway – they are stroking me big time with the refund – “We only pay out refunds at the end of the month.”, and “I’m sorry, but the Doctor has to approve all refunds and he’s gone this week. – horseshit like that.

What can I do? I know that if you submit a complaint against a Real Estate agent in my state – a blurb gets printed about it in their official state periodical – does the same thing happen with doctor’s offices? I need some sort of leverage against their bullshit.

Any ideas?


[ETA] What I mistakenly called a HSA in the above post is actually a "Health Reimbursement Account" - sorry for the confusion.
Link Posted: 8/15/2005 2:26:02 PM EDT


No it's not double dipping because they will send you a refund check. They are guarding against your crappy insurance company not sending anything and trying to track you down for the $$.

Businesses are generally good for the money, individuals are not. In other words, the average doc is a more likely to refund an overpayment to a patient than the average patient will pay their balance in a timely manner, if ever.



Link Posted: 8/15/2005 2:27:59 PM EDT

Originally Posted By Dolomite:
My story: Go in to be evaluated by a big time Orthopaedic for Plantar Fasciitis (heel spurs to you and me).

They don’t take my cheap-O insurance – they tell me that right off the bat – but they copy my insurance card and driver’s license anyway. They make me sign a waiver stating that I realize since they don’t take my insurance, I’ll be responsible for paying for services that day – fine.

The visit ends and I owe them $435 – I cut them a check, grab all the receipts I need to fill out a claim, and leave. I immediately send off the claim to my insurance company and anxiously await my reimbursement.

A few weeks go buy – according to my insurance company’s web site my claim has been “voided” and a check has been sent to my doctor’s office out of my Health Savings Account instead of me.

Why was a check sent to the Dr’s office? Because they submitted a claim to my insurance company after they took my money! Now – is that or is it not double dipping?

Anyway – they are stroking me big time with the refund – “We only pay out refunds at the end of the month.”, and “I’m sorry, but the Doctor has to approve all refunds and he’s gone this week. – horseshit like that.

What can I do? I know that if you submit a complaint against a Real Estate agent in my state – a blurb gets printed about it in their official state periodical – does the same thing happen with doctor’s offices? I need some sort of leverage against their bullshit.

Any ideas?



Dolomite,

Sorry to say this, but this kind of crap happens all the time. If I understand you correctly, you have a HSA plan? If so, you will get a monthly statement from the HSA bank/funds custodian. Additionally, you will get a EOB (Explanation of Benefits) from you Cheap-O insurance company. The EOB will show what was billed to the Insurance company and what was paid, by who and when. Compare the two. You will easily be able to see the overpayment.

FWIW, just because a Doc doesn't accept a particular insurance, doesn't mean that they won't bill to get what they can. Most companies will pay out according to "reasonable and customary" charges for the area. Others will pay "medicare allowable" or a portion thereof. Good luck and feel free to IM me if you cannot get this resolved.
Link Posted: 8/15/2005 2:32:15 PM EDT
I'd take a copy of your cancelled check and invoice and ins. co. correspondence to them and be nice. If they still give you the FOAD do not hesitate to tell them if they do not refund one or the other on the spot you will file a complaint with the medical board, state AG for deceptive practices, your HSA administrator and HR department, the BBB and consumer reports.

You paid full retail price in cash, you deserve full retail treatment.



Link Posted: 8/15/2005 2:32:54 PM EDT
That's bull, they tell you they won't take the insurance, then submit a claim anyway? You have to wait for the refund from them? Find a different Doc. Next time don't give the insurance info.
Link Posted: 8/15/2005 2:36:46 PM EDT

Originally Posted By dvr9:

Originally Posted By Dolomite:
My story: Go in to be evaluated by a big time Orthopaedic for Plantar Fasciitis (heel spurs to you and me).

They don’t take my cheap-O insurance – they tell me that right off the bat – but they copy my insurance card and driver’s license anyway. They make me sign a waiver stating that I realize since they don’t take my insurance, I’ll be responsible for paying for services that day – fine.

The visit ends and I owe them $435 – I cut them a check, grab all the receipts I need to fill out a claim, and leave. I immediately send off the claim to my insurance company and anxiously await my reimbursement.

A few weeks go buy – according to my insurance company’s web site my claim has been “voided” and a check has been sent to my doctor’s office out of my Health Savings Account instead of me.

Why was a check sent to the Dr’s office? Because they submitted a claim to my insurance company after they took my money! Now – is that or is it not double dipping?

Anyway – they are stroking me big time with the refund – “We only pay out refunds at the end of the month.”, and “I’m sorry, but the Doctor has to approve all refunds and he’s gone this week. – horseshit like that.

What can I do? I know that if you submit a complaint against a Real Estate agent in my state – a blurb gets printed about it in their official state periodical – does the same thing happen with doctor’s offices? I need some sort of leverage against their bullshit.

Any ideas?



Dolomite,

Sorry to say this, but this kind of crap happens all the time. If I understand you correctly, you have a HSA plan? If so, you will get a monthly statement from the HSA bank/funds custodian. Additionally, you will get a EOB (Explanation of Benefits) from you Cheap-O insurance company. The EOB will show what was billed to the Insurance company and what was paid, by who and when. Compare the two. You will easily be able to see the overpayment.

FWIW, just because a Doc doesn't accept a particular insurance, doesn't mean that they won't bill to get what they can. Most companies will pay out according to "reasonable and customary" charges for the area. Others will pay "medicare allowable" or a portion thereof. Good luck and feel free to IM me if you cannot get this resolved.




Not sure what is there to "resolve"? Dolo went to a MD, had a service, paid for service. Actually, he overpaid, so in a few weeks he will get a refund for the amount overpaid. In this case $435 minus his insurance company allowable=refund he will get from MD. I am guessing $150 or so is due back to Dolo.

Dolo, did you pay the $435 out of your HSA????



Link Posted: 8/15/2005 2:39:41 PM EDT
[Last Edit: 8/15/2005 2:39:56 PM EDT by Misery]
Ooh, plantar fascitis? Shit, my mom had that and they had to amputate her foot.




j/k, but it did take a long time, and surgery to fix it.
Link Posted: 8/15/2005 2:39:53 PM EDT
I think it is more their stupidity than anything.

I've seen them repeatedly bill seniors after the bill is paid two or three times.

It can't be greed.<G>

Dennis Jenkins


Originally Posted By Dolomite:
My story: Go in to be evaluated by a big time Orthopaedic for Plantar Fasciitis (heel spurs to you and me).

They don’t take my cheap-O insurance – they tell me that right off the bat – but they copy my insurance card and driver’s license anyway. They make me sign a waiver stating that I realize since they don’t take my insurance, I’ll be responsible for paying for services that day – fine.

The visit ends and I owe them $435 – I cut them a check, grab all the receipts I need to fill out a claim, and leave. I immediately send off the claim to my insurance company and anxiously await my reimbursement.

A few weeks go buy – according to my insurance company’s web site my claim has been “voided” and a check has been sent to my doctor’s office out of my Health Savings Account instead of me.

Why was a check sent to the Dr’s office? Because they submitted a claim to my insurance company after they took my money! Now – is that or is it not double dipping?

Anyway – they are stroking me big time with the refund – “We only pay out refunds at the end of the month.”, and “I’m sorry, but the Doctor has to approve all refunds and he’s gone this week. – horseshit like that.

What can I do? I know that if you submit a complaint against a Real Estate agent in my state – a blurb gets printed about it in their official state periodical – does the same thing happen with doctor’s offices? I need some sort of leverage against their bullshit.

Any ideas?

Link Posted: 8/15/2005 3:02:38 PM EDT
dvr9: The calm voice of reason in a storm of rage! Thanks for the advice – the Dr. is the Team Physician for the Milwaukee Bucks. I’m sure that when he scrapes out the dirt from under his fingernails more than $435 falls out.

I know the guy is good for it, but in the big picture I am just not that important to him or his office. For me, being out that much money means I have to make changes in my life – tomorrow, the homeless guy sitting outside of Starbucks won’t be getting his morning DeCaf Caramel Macchiato (I kid!).

In all seriousness, for the last few weeks I’ve been forced to put stuff on plastic that I normally would not, I am semi-confident I’ll get a refund, but dealing with the office’s business manager (not the best at returning phone calls, always changing her story, etc) really makes me want to submit a complaint (or at least threaten) to the State Department of Regulation and Licensing. I’m sitting here with the form all printed out – I’m going to try and call the business office big boss one more time tomorrow morning to plead my case, if I get stroked any more I think I’m going to fill it out and send it in. There's just no reason for them not to pay me.

Bubbatheredneck: Yes, the Dr’s office was paid by my insurance company out of my HSA, and yes, they cashed my personal check. When I inquired to my insurance company as to the status of the claim I submitted for my visit – they notified me that it had been canceled due to the fact that they paid the Dr (a negotiated rate I’m sure).


Now for my definition of double dipping: The of accepting of income from two mutually exclusive sources – in this case an insurance company and a private individual.
Am I wrong?
Link Posted: 8/15/2005 3:05:15 PM EDT
Go postal, I'm mean doctor.
Link Posted: 8/15/2005 3:09:00 PM EDT
Must...

Not...

Listen...

To...

Bama...
Link Posted: 8/15/2005 3:10:10 PM EDT

Originally Posted By Dolomite:
dvr9: The calm voice of reason in a storm of rage! Thanks for the advice – the Dr. is the Team Physician for the Milwaukee Bucks. I’m sure that when he scrapes out the dirt from under his fingernails more than $435 falls out.

I know the guy is good for it, but in the big picture I am just not that important to him or his office. For me, being out that much money means I have to make changes in my life – tomorrow, the homeless guy sitting outside of Starbucks won’t be getting his morning DeCaf Caramel Macchiato (I kid!).

In all seriousness, for the last few weeks I’ve been forced to put stuff on plastic that I normally would not, I am semi-confident I’ll get a refund, but dealing with the office’s business manager (not the best at returning phone calls, always changing her story, etc) really makes me want to submit a complaint (or at least threaten) to the State Department of Regulation and Licensing. I’m sitting here with the form all printed out – I’m going to try and call the business office big boss one more time tomorrow morning to plead my case, if I get stroked any more I think I’m going to fill it out and send it in. There's just no reason for them not to pay me.

Bubbatheredneck: Yes, the Dr’s office was paid by my insurance company out of my HSA, and yes, they cashed my personal check. When I inquired to my insurance company as to the status of the claim I submitted for my visit – they notified me that it had been canceled due to the fact that they paid the Dr (a negotiated rate I’m sure).


Now for my definition of double dipping: The of accepting of income from two mutually exclusive sources – in this case an insurance company and a private individual.
Am I wrong?



Dolomite,

First of all, I object to being referred to a calm voice of reason!

Seriously, my understanding of HSA law (I have sold a few) is that you have control of your account, not the insurance company. They cannot tap your account to pay claims, only you can. Additionally, did you receive a Debit Card or Checking account for your HSA Account? If so, you should have paid directly from the Account. If you paid "out of pocket," you can submit the bill and receipt showing the amount paid by you to the HSA Custodian and get reimbursed 100%.

Also, HSA's are relatively new. Most insurance companies that sell them don't have their shit together when it comes to how they work. I have yet to find a doc's office that has a decent understanding of them either. I know it sucks, but you have options on getting your money back. Let me know if you need help.

Link Posted: 8/15/2005 3:12:50 PM EDT
[Last Edit: 8/15/2005 3:24:01 PM EDT by fxntime]
Contact your State AG office, BBB and the State med board. I'd bet the SOB does it all the time and you are not the first. Lots of Docs are getting caught lately dbl dipping on Ins. Medicare and the like, they know exactly what they are doing most of the time too. Only way to put a stop to it is make a complaint. The minute you paid them, they had no business running a claim thru. If one saw how much dbl dipping and dbl bills hospitals do you'd understand why ins is so high priced. They dbl dipped my dad to the tune of 6,000 bucks while he was in. Unfortunately for them he is/was a engineer with a computer and time on his hands. I think he had fun catching them.
Link Posted: 8/15/2005 3:13:13 PM EDT

Originally Posted By Dolomite:
Must...

Not...

Listen...

To...

Bama...



Oh yeah...don't listen to Bama. His head is spinning from ogling Mrs. Bama's endowments.
Link Posted: 8/15/2005 3:15:47 PM EDT


Sure, you can complain, but it will fall of deaf ears at the state level. They will send a letter, etc etc. In the meantime you will have gotten your check, I would imagine.

Interesting, the HSA that I have lets me write the check out of the HSA, not my personal account.

I know it sucks wanting the extra $$ back in your account, but the $$ trail in medicine is really screwed up.

When dealing with insurance, a doc getting paid in 3 weeks is frickin light speed. Most docs wait 4-6 weeks to get paid for what they did. Sometimes months.

In medical circles, you won't get much sympathy for not getting your refund back in a few weeks. Not saying that's right, but that's the way it is.

Heck, the Medical College of Georgia Hospital paid me a $800 overpayment 2 YEARS later. I just got a check from a telephone company for $40 that I have been waiting on for about 10 months.

They should have done a better job of telling you they would file on your behalf and their refund policy up front.

Link Posted: 8/15/2005 3:17:48 PM EDT

Originally Posted By fxntime:
.... Lots of Docs are getting caught lately dbl dipping on Ins. Medicare and the like, they know exactly what they are doing most of the time too...



Source?
Link Posted: 8/15/2005 3:19:44 PM EDT
If they filed a claim and recieved payment from your insurance company after the fact that they told you it wasn't an accepted insurance policy, I would use that waiver they made you sign to bite them in the ass.
Link Posted: 8/15/2005 3:20:14 PM EDT
[Last Edit: 8/15/2005 3:24:31 PM EDT by Dolomite]

Originally Posted By dvr9:
Most insurance companies that sell them don't have their shit together when it comes to how they work.


That's Lumenos!

Sorry for the confusion - I've heard it referred to a Health Saving's Account so many times I think I’ve misrepresented it here. I went to the Insurance website, and the appropriate name for it is Health Reimbursement Account.

The HRA’s basically “an account” paid partially by me/partially by my employer that they can reimburse certain health expenses with. When it runs dry, I’m responsible for “a bridge” amount, and after I hit a certain dollar amount with out of pocket expenses, another form of 80/20 insurance kicks in.

Pretty sure my company is dumping them at the end of the year and going with something else (probably worse).

Originally Posted By Demordrah:
If they filed a claim and recieved payment from your insurance company after the fact that they told you it wasn't an accepted insurance policy, I would use that waiver they made you sign to bite them in the ass.


Do ya think I wish I would've kept the copy of that? Hmm?

Oh yeah - I'm sure I'll be able to get a duplicate once the girl in charge of those forms gets back from pregnancy leave and after the copier repairman finds his key to the toner cabinent.
Link Posted: 8/15/2005 3:24:29 PM EDT
[Last Edit: 8/15/2005 3:27:03 PM EDT by Red_Beard]
Sounds like you're getting fucked.

Who is your insurance company?

I'd bring it up with them, they can probably help.



as for the company taking money out of y our account, I think that wouldn't be happening for an HSA which is an individual product, but for group products like the HRA where the account is owned by you and the employer I guess it makes sense.

Link Posted: 8/15/2005 3:27:14 PM EDT

Originally Posted By Bubbatheredneck:

Originally Posted By fxntime:
.... Lots of Docs are getting caught lately dbl dipping on Ins. Medicare and the like, they know exactly what they are doing most of the time too...



Source?



When you have had multiple people in your family that have had cancer and the like it gets to be 2nd nature to check bills. It is VERY common, so much so that many insurance companies will pay YOU half the savings. My insurance Company does. It makes one check the billing very closely.
Link Posted: 8/15/2005 3:27:35 PM EDT

Originally Posted By Red_Beard:
Get your insurance company involved.

They can help.


Whoo! Oh man!

That was a good one. Jeez! My side! I hope I don't need a Doctor!

They've already explained to me 8 ways to Sunday that they've done their job and sent a check - and that's all they're going to do.
Link Posted: 8/15/2005 3:29:59 PM EDT

Originally Posted By Red_Beard:
.

...Who is your insurance company?

I'd bring it up with them, they can probably help....




Link Posted: 8/15/2005 3:30:57 PM EDT

Originally Posted By fxntime:
......It is VERY common, so much so that many insurance companies will pay YOU half the savings. My insurance Company does. It makes one check the billing very closely.




How much have you made?

Link Posted: 8/15/2005 3:32:56 PM EDT
[Last Edit: 8/15/2005 3:37:13 PM EDT by Red_Beard]

Originally Posted By Dolomite:

Originally Posted By Red_Beard:
Get your insurance company involved.

They can help.


Whoo! Oh man!

That was a good one. Jeez! My side! I hope I don't need a Doctor!

They've already explained to me 8 ways to Sunday that they've done their job and sent a check - and that's all they're going to do.



That's too bad. You should go shopping for a different company.



In this situation, the company I'm most familiar with would cancel the claim from the doctor and let you file the claim yourself.

It'd probably be a tossup as to whether or not doing that would get you your money back faster than fighting with the doctors office.


Link Posted: 8/15/2005 3:34:33 PM EDT

Originally Posted By Red_Beard:
That's too bad. You should go shopping for a different company.


True that.
Link Posted: 8/15/2005 3:36:16 PM EDT

Originally Posted By Red_Beard:

That's too bad. You should go shopping for a different company.





You have never used health insurance have you??

Insurance companies care when their money is on the line. If it is not, they couldn't care less if you lived or died. Well, actually, they don't want you to die, since they wouldn't get anymore premiums.
Link Posted: 8/15/2005 3:40:07 PM EDT

Originally Posted By Bubbatheredneck:

Originally Posted By Red_Beard:

That's too bad. You should go shopping for a different company.





You have never used health insurance have you??


heh heh heh




Insurance companies care when their money is on the line. If it is not, they couldn't care less if you lived or died. Well, actually, they don't want you to die, since they wouldn't get anymore premiums.




If you have a favorable to them claims history they'll often go out of their way to keep you as a customer.


Link Posted: 8/15/2005 3:42:45 PM EDT

Originally Posted By Red_Beard:


If you have a favorable to them claims history they'll often go out of their way to keep you as a customer.





The problem is, in most cases, the customer is your employer. The one they want happy is the one writing the premium checks. If enough employees scream about crappy health insurance, it can be changed, but it is hard.

Link Posted: 8/15/2005 3:43:28 PM EDT
Was the ins. co check less than your check? Then get your check reimbursed. Acceptance of a check represents accord and satisfaction. They accepted the lesser amount as payment, get the higher amount reimbursed.

Go in the office and start speaking loudly but non-threateningly, if necessary, in front of grandma and the little girls about what insurance frauds these people are. If they threaten to call the police whip out your phone and do it for them. Tell them you're going to file a criminal complaint for theft by fraud and a corresponding small claims court case for damages. They know they'll spend XXX your issue just by picking up a phone to their insurance carrier even if it is all B.S.

Just don't plan on getting operated on by the doc, who is likely using up your $400 wiping up a cheap hooker in Barbados as I type this drivel. he
Link Posted: 8/15/2005 3:45:51 PM EDT
Before our Company changed Ins companys about 800 bucks. It is rampant in the medicare side of the biz, see plenty of them in the Detriot paper where it goes up to 500 + K and more. It seemed to peak about 2 years ago but it still is pretty common. How else do you think they pay for all the indigents and illegals? I'm not saying that they make all their money back but that it happens a lot more then people think because if one has insurance there is a tendancy to not bother checking.
Link Posted: 8/15/2005 3:51:54 PM EDT
[Last Edit: 8/15/2005 3:53:44 PM EDT by Bubbatheredneck]

Originally Posted By PaintItBlack:
Was the ins. co check less than your check? Then get your check reimbursed. Acceptance of a check represents accord and satisfaction. They accepted the lesser amount as payment, get the higher amount reimbursed.




No, he was told up front they don't accept his insurance company's arbitary fee schedule as full payment for services rendered.

You know, the part you sign with all the fine print?
Link Posted: 8/15/2005 3:53:48 PM EDT
I hate doctors offices and the way they act like they're doing you a favor just to let you into their place of business. How well they've forgotten that they work for us, not the other way around.
Link Posted: 8/15/2005 3:54:10 PM EDT

Originally Posted By PaintItBlack:
Acceptance of a check represents accord and satisfaction.


I like that. Gonna have to remember to bring that up.


Go in the office and start speaking loudly but non-threateningly, if necessary, in front of grandma and the little girls about what insurance frauds these people are. If they threaten to call the police whip out your phone and do it for them.


I really don't want to do that. And not because it's some ghetto Dr's office with red carpet on the walls - I'm sure they'll pay me eventually because $435 is nothing to them - but it's a lot to my poor ass and I'm tired of getting the run around.
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