topic Re: Very Frustrated With Doctor's Offfice Over Insurance!! in Community Chat

Very Frustrated With Doctor's Offfice Over Insurance!!

lucieinthesky — Tue, 26 Jul 2016 22:37:59 GMT

I',m hoping someone here can give me some advice because I am at my wit's end. In March I had cataract surgery on both eyes. Upon going in the waiting room on the day of the first surgery, I am told how much I needed to pay up front (basically the amount not covered by insurance). I must say, I was a bit surprised by how much I had to pay because I have very good health insurance through my husband's employer as well as Medicare. Two weeks later, I have the second eye done and pay the same amount that day.

A couple of weeks later, I learn that they were not even aware that I had the Medicare and did not take that into consideration when calculating how much I would have to pay. I had given them the Medicare info last year at my last appointment, so they should have known. Anyway, they file on it.

Here we are, 4 months later ----I have statements from Medicare showing their payment to the eye clinic, but I have not received a refund from the clinic. (Trying not to make this too long of a story) I have called and spoken to the same lady in the insurance/claims dept. at the eye clinic and she keeps telling me that they have not received payment from Medicare. I tell her that I have talked to medicare and they HAVE made payment to them. So, today I call and ask to speak to her supervisor. I get that person's voicemail and leave a message. Naturally, I get no call back. Not sure what my next step needs to be -- maybe State Board of Insurance to file a complaint.

Re: Very Frustrated With Doctor's Offfice Over Insurance!!

Ms X — Tue, 26 Jul 2016 22:23:33 GMT

@lucieinthesky wrote:
I',m hoping someone here can give me some advice because I am at my wit's end. In March I had cataract surgery on both eyes. Upon going in the waiting room on the day of the first surgery, I am told how much I needed to pay up front (basically the amount not covered by insurance). I must say, I was a bit surprised by how much I had to pay because I have very good health insurance through my husband's employer as well as Medicare. Two weeks later, I have the second eye done and pay the same amount that day.

A couple of weeks later, I learn that they were not even aware that I had the Medicare and did not take that into consideration when calculating how much I would have to pay. I had given them the Medicare info last year at my last appointment, so they should have known. Anyway, they file on it.

Here we are, 4 months later ----I have statements from Medicare showing their payment to the eye clinic, but I have not received a refund from the clinic. (Trying not to make this too long of a story) I have called and spoken to the same lady in the insurance/claims dept. at the eye clinic and she keeps telling me that they have not received payment from Medicare. I tell her that I have talked to medicare and they HAVE made payment to them. So, today I call and ask to speak to her supervisor. I get that person's voicemail and leave a message. Naturally, I get no call me back. Not sure what my next step needs to be -- maybe State Board of Insurance to file a complaint.

Call your state governor's office and ask them who within their bureaucracy can help you. They might have a consumer protection division or insurance division or both whom you can contact. Then you can call them and get more info. I'd find out what my rights are and then call the DOCTOR back and demand a refund with a DEADLINE SPECIFIED BY ME unless they want you to file a formal complaint. You might want to put it in writing. I do not believe they have ANY RIGHT to ask you to pay them while they wait for Medicare. Most medical providers are TERRIFIED of being investigated by Medicare for fraud, so I'd imgaine they wouldn't want to raise any red flags.

Call the governor, talk to whomever they refer you to at the state level who oversees this kind of thing, and then call them with SPECIFIC DEMANDS about what they must do and WHEN.

Re: Very Frustrated With Doctor's Offfice Over Insurance!!

MyGirlsMom — Tue, 26 Jul 2016 22:06:49 GMT

Stop calling.

Go to the office wit your EOB's from Medicare and speak to someone directly in the claims department.

Re: Very Frustrated With Doctor's Offfice Over Insurance!!

10grands — Tue, 26 Jul 2016 22:13:09 GMT

Make a copy of the Medicare statement showing they paid and go into the office and ask to speak to the person handling insurance claims. If that does not work, ask for Office Manager.

At this point going to other agencies will prolong your situtation, and I would only do that as a last resort.

Re: Very Frustrated With Doctor's Offfice Over Insurance!!

KathyPet — Tue, 26 Jul 2016 22:14:25 GMT

@MyGirlsMom wrote:
Stop calling.

Go to the office wit your EOB's from Medicare and speak to someone directly in the claims department.

ITA. Stop calling! Take the form you received fromMedicare showing that they paid and go into their office and insist on speaking to the person who,handles the billings.

Re: Very Frustrated With Doctor's Offfice Over Insurance!!

Imadickens — Tue, 26 Jul 2016 22:17:01 GMT

ask Medicare for statement showing payment to clinic, date, amount, etc. Then, call clinic, tell them you have statement and send them a copy of it with the date you wish to have payment received! Tell them if you don't receive it by that day you will report them to (whoever it is that oversees physicians in your state) and Medicare for fraud/double payment. If that doesn't work, state atty. general or hire a lawyer! Sending good thoughts to you!

Re: Very Frustrated With Doctor's Offfice Over Insurance!!

MKR14 — Tue, 26 Jul 2016 22:21:20 GMT

I worked in doctor offices for over 20 years and know what you mean. Our office did not receive some Medicare payments as Medicare said. Most we received and all was posted and a refund credited to the patients account. If the patient was coming in for an appointment we would leave the credit there until we asked them if they wanted a refund. In your case when the Medicare payment would have been posted, overpayment would be a refund to the patient. Some patients that were in the office for chronic problems would want the refund left as credit on the account. I remember the billers contacting Medicare letting them know we never received their check. Some may have lost and some were sent directly to the patient in error and they cashed and "kept them". Please hang on and give your office time to investigate for you. An honest office will do their best for you. Some of the patients that got the check would tell us they cashed it as they thought it was theirs. If they didn't pay us our portion they would go to collection. If you can get a copy or have a copy of the EOB ( the paper with all the data you receive from Medicare- Explanation of Benefits- it would be just what the office needed to track where the check went. The Date of Service on the statement you received will show the office where it was posted IF they ever received it. Maybe it got posted to an account with the same or similar name as yours by mistake. Even a very detailed person could make that mistake on a busy day. Let us know how you make out.

Re: Very Frustrated With Doctor's Offfice Over Insurance!!

lucieinthesky — Tue, 26 Jul 2016 22:29:12 GMT

Good advice from everyone. I will not make any more calls to them. I will just take my EOB from Medicare and go demand my reimbursement!

Re: Very Frustrated With Doctor's Offfice Over Insurance!!

10grands — Tue, 26 Jul 2016 22:37:38 GMT

I know you are upset and have every right to be, but when you go approach it with a calm attitude.

Re: Very Frustrated With Doctor's Offfice Over Insurance!!

lucieinthesky — Wed, 27 Jul 2016 01:40:51 GMT

@10grands wrote:
I know you are upset and have every right to be, but when you go approach it with a calm attitude.

You'r right - I am quite upset with these people. Obviously, they created this problem themselves -- as I said, I had given them my Medicare card to copy LAST year. It should have been in my file. However....... I will do my best to stay calm when I go in to talk with them.

Re: Very Frustrated With Doctor's Offfice Over Insurance!!

Ms X — Tue, 26 Jul 2016 22:45:28 GMT

@lucieinthesky wrote:
@10grands wrote:
I know you are upset and have every right to be, but when you go approach it with a calm attitude.
You'r right - I am quit upset with these people. Obviously, they created this problem themselves -- as I said, I had given them my Medicare card to copy LAST year. It should have been in my file. However....... I will do my best to stay calm when I go in to talk with them.

That's probably good advice, but I wouldn't be calm unless I intended to return to that practice. I find that people who blow you off and step all over you will continue to do so if you remain "calm" and "nice." At some point, I say to myself "it's Leona Helmsley time" and then I tell them just what I think and just what I expect of them N-O-W. I always get my way when I do that. There is a limit to what a person should be expected to take in a situation like this. Maybe you could start out kind but change your tactics if they continue to refuse to solve the problem. A favorite tactic of mine is to speak loudly in front of the other customers deliberately. I admit that I can be horrible, but I love to do it when provoked.

Re: Very Frustrated With Doctor's Offfice Over Insurance!!

fortune — Tue, 26 Jul 2016 22:52:37 GMT

@lucieinthesky wrote:
I',m hoping someone here can give me some advice because I am at my wit's end. In March I had cataract surgery on both eyes. Upon going in the waiting room on the day of the first surgery, I am told how much I needed to pay up front (basically the amount not covered by insurance). I must say, I was a bit surprised by how much I had to pay because I have very good health insurance through my husband's employer as well as Medicare. Two weeks later, I have the second eye done and pay the same amount that day.

A couple of weeks later, I learn that they were not even aware that I had the Medicare and did not take that into consideration when calculating how much I would have to pay. I had given them the Medicare info last year at my last appointment, so they should have known. Anyway, they file on it.

Here we are, 4 months later ----I have statements from Medicare showing their payment to the eye clinic, but I have not received a refund from the clinic. (Trying not to make this too long of a story) I have called and spoken to the same lady in the insurance/claims dept. at the eye clinic and she keeps telling me that they have not received payment from Medicare. I tell her that I have talked to medicare and they HAVE made payment to them. So, today I call and ask to speak to her supervisor. I get that person's voicemail and leave a message. Naturally, I get no call me back. Not sure what my next step needs to be -- maybe State Board of Insurance to file a complaint.

I had a gastroenterologist charge me up front for two visits--over $300. I have Medicare and Aetna. They said at the time something about this being my copay and deductible, etc., etc. I then received notifications from both Medicare and Aetna that they had reimbursed the doctor. Of course I called and stated the facts. They then said oh, I guess we'll send you a refund of what was owed me. I know for a fact that they NEVER would have refunded me the money unless I had called and insisted.

I consider this a scam. You need to speak to the doctor in your case and let him know that he owes you money. Check with both of your insurance companies so that you have the paperwork of their reimbursing the doctor. Tell the doctor that you have this paperwork and that you will report him if he hesitates or delays in sending you the money he owes you. Also tell him you're going to write a review of his illegal practices on the Internet--doctors review sites, Better Business Bureau, and Angie's List.) Good luck!!

Re: Very Frustrated With Doctor's Offfice Over Insurance!!

newagain888888 — Tue, 26 Jul 2016 22:47:49 GMT

I would first reccommend that you put everything that has happened with as much detail (dates, persons you dealt with, payments made, etc.) as possible in a letter and send it by certified mail to the medical office. Be sure to request signature and proof of delivery. Let them know you were overcharged months ago and that you are owed you a refund. Explain that you have also notified Medicare in writing of the issue.

Your bank usually has a notary who will notarize your letter free of charge. It's not essential but a notarized letter packs a little more punch since it is a legal document. Submitting pertinent details will highlight the problem and make clear exactly what they need to do to correct it. Send a copy of this letter to Medicare requesting intervention on their part since they claim to have paid the doctor's office and will have proof of that payment. Certified letters have a way of getting the most attention and usually quickly. Best of Luck!

Re: Very Frustrated With Doctor's Offfice Over Insurance!!

lucieinthesky — Tue, 26 Jul 2016 22:53:57 GMT

@Ms X wrote:
@lucieinthesky wrote:
@10grands wrote:
I know you are upset and have every right to be, but when you go approach it with a calm attitude.
You'r right - I am quit upset with these people. Obviously, they created this problem themselves -- as I said, I had given them my Medicare card to copy LAST year. It should have been in my file. However....... I will do my best to stay calm when I go in to talk with them.
That's probably good advice, but I wouldn't be calm unless I intended to return to that practice. I find that people who blow you off and step all over you will continue to do so if you remain "calm" and "nice." At some point, I say to myself "it's Leona Helmsley time" and then I tell them just what I think and just what I expect of them N-O-W. I always get my way when I do that. There is a limit to what a person should be expected to take in a situation like this. Maybe you could start out kind but change your tactics if they continue to refuse to solve the problem. A favorite tactic of mine is to speak loudly in front of the other customers deliberately. I admit that I can be horrible, but I love to do it when provoked.

Oh, no -- I do not intend to return to that practice for anything, even though, I have been using them for over 10 years.

Re: Very Frustrated With Doctor's Offfice Over Insurance!!

MKR14 — Tue, 26 Jul 2016 22:56:00 GMT

An organized office staff are required to see your Medicare card-especially before surgery- to verify you still have the insurance and it is the same ID number. If your spouse has passed away tou will have a new card and ID and different letter at the end. A Retired Railroad Employees Medicare card has a different address than regular Medicare for submitting claims also. It is for your protection to have them verify it as sometimes you may only have Part A and not Part B as well. Part B coverage is for office calls and Part A coverage is for hospital. Some patients only had one of the coverages. Also there may be that your yearly deductible hasn't been met for the year if you are a healthy person and don't see a doctor very much. It sounds like they were doing a good job and will get to the bottom of what is going on for your benefit as well as address your problem. IIt is frustrating as we all deal with this every now and then. I enjoyed my job and would have asked to see and copy your card once a year also.

Re: Very Frustrated With Doctor's Offfice Over Insurance!!

Carmie — Tue, 26 Jul 2016 23:14:13 GMT

If you have Medicare as your primary payer, a medical provider should not bill you up- front for deductibles and coinsurance. They need to wait for the Medicare payment in order to know how much you should be billed.

Is your insurance at DH workplace a Medicare suppliment, or secondary to Medicare? Your Group insurance from work could also be primary over Medicare. Does the doctor participating with Medicare and/ or your other insurance plan? This makes a big difference.

You should make yourself aware of how your indvidulal insurance plans works. Every time you have services, remind the office and give them your insurance cards, especially when you have expensive lab or surgical care.

fyi: Medicare does not send your doctor a check. They deposit the money into his account and send the practice a statement showing what they paid and for whom. Somestimes, the statement is a hundred pages with thousands of patients listed, especially if the practice is large with many doctors. This is why it "Takes so long for payments to be posted to your account."

I would agree to make a copy of the EOMB and take it to the office and request a refund in person. You can also download payment information from the Medicare website if you have misplaced the EOMB or didn't get a copy.

The office will probably make you wait until they have posted the Insurance payments from all of your plans before they cut you a check.

In the future, DO NOT pay up- front, especially if the provider accepts your insurance plan.

Re: Very Frustrated With Doctor's Offfice Over Insurance!!

Melania — Tue, 26 Jul 2016 23:17:46 GMT

I feel your pain. We are having an issue with our dentist staff not filing the information correctly even going talking face to face does nothing. I think the person who handles it is on something. She is so lazy and clueless.

Even our insurance company calls them and tells to fax it over to them...nothing.

I think we are going to have to write the dentist a note or talk to him face to face. I'm sure he has no clue what's going on.

They have the info. and send us a bill and say insurance was filed when it wasn't. They aren't getting a penny until they file until correctly.

Re: Very Frustrated With Doctor's Offfice Over Insurance!!

lucieinthesky — Tue, 26 Jul 2016 23:23:43 GMT

@Carmie wrote:
If you have Medicare as your primary payer, a medical provider should not bill you up- front for deductibles and coinsurance. They need to wait for the Medicare payment in order to know how much you should be billed.

Is your insurance at DH workplace a Medicare suppliment, or secondary to Medicare? Your Group insurance from work could also be primary over Medicare. Does the doctor participating with Medicare and/ or your other insurance plan? This makes a big difference.

You should make yourself aware of how your indvidulal insurance plans works. Every time you have services, remind the office and give them your insurance cards, especially when you have expensive lab or surgical care.

fyi: Medicare does not send your doctor a check. They deposit the money into his account and send the practice a statement showing what they paid and for whom. Somestimes, the statement is a hundred pages with thousands of patients listed, especially if the practice is large with many doctors. This is why it "Takes so long for payments to be posted to your account."

I would agree to make a copy of the EOMB and take it to the office and request a refund in person. You can also download payment information from the Medicare website if you have misplaced the EOMB or didn't get a copy.

The office will probably make you wait until they have posted the Insurance payments from all of your plans before they cut you a check.

In the future, DO NOT pay up- front, especially if the provider accepts your insurance plan.

Husband's insurance is primary, medicare secondary. Yes, the office has been saying that they were waiting for payments to come in for both surgical procedures and both clinic costs before issuing any reimbursement to me. However, as recent as 2 weeks ago they were telling me that they had not received payment for the second surgery when Medicare shows to have isssued payment on June 9th.

I can understand that I would not pay up-front if Medicare were my primary, but it isn't.

Re: Very Frustrated With Doctor's Offfice Over Insurance!!

muttmom — Tue, 26 Jul 2016 23:35:00 GMT

Why isn't Medicare your primary and your husband's insurance secondary?

Re: Very Frustrated With Doctor's Offfice Over Insurance!!

lucieinthesky — Tue, 26 Jul 2016 23:44:24 GMT

@muttmom wrote:
Why isn't Medicare your primary and your husband's insurance secondary?

That I really don't know. I would suppose it is because I had husband's insurance before becoming eligible for Medicare. Are you telling me Medicare should be my primary?