Very Frustrated With Doctor's Offfice Over Insurance!!

lucieinthesky · ‎01-14-2013

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.

Ms X · ‎09-13-2012

@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.

MyGirlsMom · ‎03-09-2010

Stop calling.

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

Keep Your Face To The Sunshine and You Will Not See The Shadow

10grands · ‎03-10-2010

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.

KathyPet · ‎03-09-2010

@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.

Imadickens · ‎06-15-2016

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!

Never underestimate the power of kindness.

MKR14 · ‎03-09-2010

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.

lucieinthesky · ‎01-14-2013

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!

10grands · ‎03-10-2010

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

lucieinthesky · ‎01-14-2013

@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.