My med providers are stealing from me

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cured4real?
Veteran Member


Date Joined Dec 2005
Total Posts : 1944
   Posted 7/11/2007 4:38 AM (GMT -7)   
Hi--
I have a medicare PPO plan and that gives me a 15 copay to my regular physician and a 30 copay to a specialist.  Most xrays and stuff are covered, but sometimes there is a small amount due for labs.  The disgusting thing is that a doctor will tell me they take my insurance, then I go see them and pay the copay and then they will send me a bill for hundreds of dollars above the medicare approved amount. They know that the plan only pays the medicare approved amount and I pay extra for the plan to cover the difference between the 25% deductible for medicare and my smaller copay. I'm so disgusted.  I'm starting to refuse to pay, but all my docs just started this illegal practice, except my rhuemie and primary care, thank God, because they are decent people.  I am already having to switch endocrinologists, she was good, but a joke, demanding over 300 a visit and expecting all of it from me.  I actually asked her office how they could get up in the morning and face themselves in the mirror.  Isn't there some law that says that if they bill your insurance, they must abide by its terms?  If they say they "take" my insurance, I'm assuming that they will abide by its terms.  I'm planning on sending them explanations of benefits, showing that they are in the wrong, and I've called the insurance company, but they won't get involved, they keep saying that if I ever signed anything that says I will pay any remaining cost, that that includes these illegal costs.  I would be better off just having straight medicare at this point.  Unfortunately, I'm 70 dollars over the limit for medicaid to fill in where medicare leaves off and social security won't pay me less.  I'm so disgusted.  I'm also running out of providers who take this plan.  I hate this country.  I've called board of insurance, but in my state they are just an answering machine and they are really corrrupt.  I don't know what to do.
Love, Marji
--Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less in human beings of whom they know nothing.--Voltaire (1694-1778)
Ills--Sjogrens-Lupus-like AI Disease, Hashis, Vitiligo, spinal stenosis/fusion with plate, salivary/lymphectomies, Diabetes, NAFLD, COPD, RLS, neuropathy, trigonitis, hystero, diffuse brain atrophy
Meds--Plaquenil, Evoxac, Metformin, Synthroid, HCTZ, Estradiol patch, Prosed, Klonopin, Soma, Ultram, Vicodin, Restasis, Albuterol,steroid injections, Protopic & Triamcinolone Acetonide ointments


Juliaa
Regular Member


Date Joined Feb 2006
Total Posts : 131
   Posted 7/11/2007 6:21 AM (GMT -7)   
Hello Marji- Your situation makes me so angry. I've had interactions with providers offices that started out fine then all of a sudden they were billing for over the co pay too. I hope this little bit of info helps. First the Doctor signed with your insurance company.

When they accept your insurance company's money with as a Per. Provider they are bound to the contract they signed. So contact your insurance company, many will battle with the doc. for you.

"they keep saying that if I ever signed anything that says I will pay any remaining cost, that that includes these illegal costs" That is if your insurance company rejects the claim and doesn't pay anything. Then you are responsible for the bill. If they have been paid no dice for them. Second If they have not been paid find out why. We argued for 6 months over a surgery bill for my daughter, they also were sending us to collections, because our insurance company had not paid them. The Doc's billing department INSISTED they had billed our insurance & recieved no response. TURNED OUT THEY WERE BILLING THEIR OWN SPRINKLER COMPANY FOR MY DAUGHTERS SURGERY! Once the rep. straightened that out & stopped laughing; the claim was paid. Please let us know how this is going. Best of Luck and Gods speed.


DX:  Migraine; SLE; Diverticulitis;HB;neuropathy seizures; Sjogrens
 
Micardis, plaquenil,Prednisone, anti seziure drug, & Nsaids

Post Edited (Julia20) : 7/11/2007 7:24:17 AM (GMT-6)


dbab
Veteran Member


Date Joined Jan 2004
Total Posts : 4151
   Posted 7/11/2007 9:08 AM (GMT -7)   
I agree with Julia. These doctors do contract with the insurance companies and must only charge the price negotiated through your insurance. When my EOB's come in from my insurance is when I pay my portion of the bill as I always compare what they have and what the bill says. They do put in bold letters also to not pay more than what it says is my responsibility on the EOB because the physician has agreed to the terms. Doctors have a choice on which insurance companies to accept, if they accepted your insurance, they accepted the terms. I would call your insurance company again and asked to speak to someone higher up.

Good luck and Take Care
"Des"
Co-Moderator ~ IBS Forum
Co-Moderator ~ Lupus Forum 
Dx: IBS 1989, Diverticulosis 2004, Idiopathic Acute Colitis 2006, UCTD 2007
Meds: Plaquenil 400mg, Chlorzoxazone 500mg, Lyrica 50mg, Protonix 40mg, Naproxen 1000mg, Klonopin 2mg/day (tapering to PRN), Miralax 17g, Supplements


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gloryroad
Regular Member


Date Joined Oct 2006
Total Posts : 193
   Posted 7/11/2007 2:19 PM (GMT -7)   
I would report this to the insurance company.
Gloryroad


okie
Veteran Member


Date Joined Dec 2006
Total Posts : 2818
   Posted 7/11/2007 5:55 PM (GMT -7)   
Hi marji, I really hate dealing with doctors and their obsorbinent amounts of money they want. My insurance company is like yours. I pay 25% of what they agree to pay not what they charge. If they try to go to me for the difference my insurance company wants to know. Of course I have military insurance and it's hard to fight the government. I was on with my insurance company yesterday because I have a cap of 3000.00 dollars a year. So last year I had a bill for 12 thousand dollars. it turned out to be that I would have to pay like 1500 after they negotiated with the hospital. But what the insurance company did it not pay it right away. So it didn't go toward my cap. instead they did smaller amounts throughout the year and I wasn't hitting my cap. Than the middle of nov. they paid it. Which of course put my over the cap. I don't even know by how much. Had they done it before it could have been 1400.00 dollars over my cap for all I know. Of course they won't pay me back trhe difference. They just say well we'll pick up the rest of of the year. Right there was only 2 weeks left. That's just not fair.!
anyway My opinion they are all crooks.
hugs
carol
God Bless
Carol
Lupus, possible Crest, COPD, Cervical Cancer survivor. Osteoporosis
Prednisone 5mg, Plaquanil 800mg,Evista60mg, Effexor 150mg, HCTZ25/Triamterene37.5mg,Xanax.5mg
 
When things are really dark look up. You can see the stars.
 
 
 


cured4real?
Veteran Member


Date Joined Dec 2005
Total Posts : 1944
   Posted 7/12/2007 10:00 AM (GMT -7)   

Thanks, you guys.  I have a medicare replacement policy, which is supposed to cover my part D prescription drugs and give me a little break (though not much) over what medicare would have me pay.  It takes hours to get through (humana) and when I finally do, they just don't do anything.  They will not call the doctor or anything.  I may see if that patient advocate site works in this case.  My son has medicaid, 100% coverage, through Amerigroup and his cardiologist just sent a bill for 700.00 minus the 50.00 amerigroup paid.  My son is freaking out.  It's so disgusting. Because he is 18 I can't deal with it for him without sending in a signed letter.  I'm just so disgusted with doctors these days.  It's bad enough being poor without having them ruin your credit and do this crap.  Where I live, its all on you if you are poor, as far as debts go.  The only reason they get away with this is because they know we are too sick to get together and march to the white house or something, not that anyone there would care.  I think all government officials should have social security as their pension and health coverage.  Then social security would be liquid, the ious against it paid back by the crooks that stole the money, and our benefits would not be a joke.  Course, most government people would probably quit!


Love, Marji
--Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less in human beings of whom they know nothing.--Voltaire (1694-1778)
Ills--Sjogrens-Lupus-like AI Disease, Hashis, Vitiligo, spinal stenosis/fusion with plate, salivary/lymphectomies, Diabetes, NAFLD, COPD, RLS, neuropathy, trigonitis, hystero, diffuse brain atrophy
Meds--Plaquenil, Evoxac, Metformin, Synthroid, HCTZ, Estradiol patch, Prosed, Klonopin, Soma, Ultram, Vicodin, Restasis, Albuterol,steroid injections, Protopic & Triamcinolone Acetonide ointments

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