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Who’s at Fault? Medical Billing Dept. or Insurance Company?
I needed to see a dermotologist and found a provider for my insurance. I saw a physician’s asst. and didn’t get a bill for 2 months, after my 4th visit. They were billed under another dr., not the dr. who I had asked for. The dr. they billed under was out-of-network. I talked to the billing dept. and they waived a lot of fees. I asked them why they didn’t submit it under the dr.’s name who I had requested. They said he doesn’t work at that office, he just owns the clinic. They said that it would be fraud to list anything under his name since he doesn’t practice at that specific clinic. However, the insurance company has him listed as a provider at that specific location. I looked at their website today and called the hotline, and they said he is still listed as a provider. Does this mean I need to fight the insurance company? I have called both parties so many times and don’t know who to blame anymore. At this point, it just looks like I’m reaching. Help!
Ask your insurance co. if it’s fraudulent for the Dr’s office to bill you under another name, and especially when you weren’t seen by ANY Dr., and only a psysicians ass’t?
But also? It seems to me that the ins co has a responsibility to keep their roster up to date. Failing to do that, they induced you to seek treatment that is not covered. Do NOT pay anthing till this is resolved. Good luck!
The faculty where you are being seen at needs to eat the cost, they has it listed as a providing provider they are fully aware of what they are doing did not tell you so they are responsible the insurance company only pay for the service at out of net work prices.
This sounds fishy to me all the way around. I work for a group practice, and as long as ONE of my docs is in your network, we take your insurance – all of our bills go out under one Tax Id#. That said, the provider has a responisibility to bill the claims under the name of doctor the patient sees. To do anything else is fraudulent – except in the case of a PA or Nurse Practitioner – those can be billed under the name of the supervising MD. The insurance company has the right to audit patient charts at any time, and if they find this the provider will be required to refund the payments.
However, insurance company rosters are rarely up to date. I have some insurance companies that list us at a location we vacated 11 years ago! There’s another that wanted to verify the information of a doctor who left our practice six years ago.