If a medical office (imaging center) accepts your insurance card before treatment, can they then refuse to deal with your insurance company afterwards and expect you to pay the bill?
Total Comments: 4
Posted: Sun Dec 27, 2009 12:37 pm Post Subject:
I would think so yes...I've never seen a health insurance card that didn't say something along the lines of "this card does not guarantee coverage"
What is the issue? Is your carrier refusing to pay?
Posted: Sun Dec 27, 2009 02:30 pm Post Subject:
No, My insurance company is willing to pay. The vendor is refusing to send a correctly completed claim form.
Step by step:
1. Vendor accepted my insurance card.
2. vendor sent insurance co. incorrect claim form.
3. Insurance co. requested a corrected claim form.
4. Vendor refused and sent me the bill.
5. This has gone into collection because I refuse to pay.
I believe that having accepted my insurance, the vendor is bound to make a good faith effort to collect from my insurance co. Sending one incorrect claim form is hardly a good faith effort.
My insurance co is willing to pay and has paid on two previous occasions for the same procedure, at a different place.
Posted: Mon Dec 28, 2009 06:02 am Post Subject:
A provider accepting an insurance card and actually being a member of that network are two different things. The place you went could say..... yes we accept your insurance, meaning that they will bill your insurance but that you may be responsible for some or all of the charges.
When you say incorrect form....why was it incorrect. Did they code it wrong, either by diagnosis or procedure? Many times providers bill procedures certain ways and if they are not part of the network they will not change their billing procedures.
Is the provider in your network.... if so they need to follow the networks conditions. If not, they are under no obligation to do so.
Collections....I understand that you think this should be covered, but by not paying the bill and handling further with your insurance company and provider you are the only one hurt in the process.
Posted: Sat Jan 02, 2010 06:38 am Post Subject:
If the service you received would have been covered by your insurance, pay the bill and submit it to your insurance company for reimbursement. The insurer must accept or deny your claim within a limited period of time. But you generally only have 1 year from the date of service, in most states, to submit your claim.
[A side issue might develop around whether you signed an authorization making the service provider your "agent" in processing the claim with your insurer. If you did, then their failure to submit the claim properly, and their refusal to comply with the insurer's request for proper information violates their relationship with you, the "principal". Under most states' laws, it would relieve you of responsibility for all but the amount of the service the insurer would not have covered.]
If they deny, you can then get your state Department of Insurance involved by filing a consumer complaint. There could be sanctions imposed on the insurer, the service provider, or both, depending on the state in which you reside and the actual facts.
Posted: Sun Dec 27, 2009 12:37 pm Post Subject:
I would think so yes...I've never seen a health insurance card that didn't say something along the lines of "this card does not guarantee coverage"
What is the issue? Is your carrier refusing to pay?
Posted: Sun Dec 27, 2009 02:30 pm Post Subject:
No, My insurance company is willing to pay. The vendor is refusing to send a correctly completed claim form.
Step by step:
1. Vendor accepted my insurance card.
2. vendor sent insurance co. incorrect claim form.
3. Insurance co. requested a corrected claim form.
4. Vendor refused and sent me the bill.
5. This has gone into collection because I refuse to pay.
I believe that having accepted my insurance, the vendor is bound to make a good faith effort to collect from my insurance co. Sending one incorrect claim form is hardly a good faith effort.
My insurance co is willing to pay and has paid on two previous occasions for the same procedure, at a different place.
Posted: Mon Dec 28, 2009 06:02 am Post Subject:
A provider accepting an insurance card and actually being a member of that network are two different things. The place you went could say..... yes we accept your insurance, meaning that they will bill your insurance but that you may be responsible for some or all of the charges.
When you say incorrect form....why was it incorrect. Did they code it wrong, either by diagnosis or procedure? Many times providers bill procedures certain ways and if they are not part of the network they will not change their billing procedures.
Is the provider in your network.... if so they need to follow the networks conditions. If not, they are under no obligation to do so.
Collections....I understand that you think this should be covered, but by not paying the bill and handling further with your insurance company and provider you are the only one hurt in the process.
Posted: Sat Jan 02, 2010 06:38 am Post Subject:
If the service you received would have been covered by your insurance, pay the bill and submit it to your insurance company for reimbursement. The insurer must accept or deny your claim within a limited period of time. But you generally only have 1 year from the date of service, in most states, to submit your claim.
[A side issue might develop around whether you signed an authorization making the service provider your "agent" in processing the claim with your insurer. If you did, then their failure to submit the claim properly, and their refusal to comply with the insurer's request for proper information violates their relationship with you, the "principal". Under most states' laws, it would relieve you of responsibility for all but the amount of the service the insurer would not have covered.]
If they deny, you can then get your state Department of Insurance involved by filing a consumer complaint. There could be sanctions imposed on the insurer, the service provider, or both, depending on the state in which you reside and the actual facts.
You don't want to be involved in collections.
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