HI.
Ugh. I am so frustrated. I need your mom's advice.
i was talking my son to a speech therapist evaluation. We had about 4-5 appointments. I called the speech therapist in early January looking to make an appointment. She said that she needed to submit my insurance information to see how much would be covered. Two weeks later, she tells me that they are covered at 100% with $30 co-pay. I agree to start the appointments. After collecting my co-pay for 5 weeks, the speech therapist tells me that we are done and that we will have a final appointment for a feedback session. Well, the speech therapist calls me last week to tell me that records review is not covered, after I spent a lot of time scanning in and sending reports and videos of my son. I said fine, don't review them, some of the reports are old anyway. But she said that the feedback session will be covered at $30 co-pay and we made an appointment this Friday. Well, her insurance office calls and says none of the appointments were covered. Well, I had a bad feeling about this because just earlier this week, I look at my online claims and say that the therapist was being covered as out of network, and they wanted a $600 deductible and 30% coverage,so with my calcualtions I am left holding the bag for $870. as opposed to $150-$180. I called the speech therapist and cancelled our appointment for tomorrow and told her to just send the report. I feel there were two big mistakes that were made, A) they told me the wrong price initially and B) they submitted the claims 2 months too late and then want me holding the bag. What I really think happened is that the insurance lady in the front office screwed up and she interpereted the $30 co-pay instead of a $30 discount and now she is lying to save her rear end and saying the insurance company gave her the wrong inforamtion. Truth be told, I would have looked elsewhere for a speech therapist if I had known the real price. Have any of you moms been in this situation? What re-course do I have?
Thanks.
Thanks for the responses. Apparently, the same thing happened with a different patient. I think the office might have submitted the claim wrong, mental vs. medical. I may still be responsible, but I am going to work out an arrangement such that I do not get billed the full amount, but they are paid fairly. Because quite frankly, they are charging a really high rate, 3 times as much as my pediatrician makes or more. Since it took two weeks, I thought the office knew what they were doing and it obviously was not the firs ttime they have dealt with insurance. This was for a speech evaluation not therapy. he gets therapy through the school district.
Always call and talk directly to the insurance company and get names and times, etc. They know better than the offices of doctors or therapists so in the future take time to call them.
Without anything in writing from the speech therapist's office there really isn't any recourse, because unfortunately its up to the insured to know the benefits of their plan. However, if there is a signed cost estimate, you could try the office manager and see if maybe they'd be willing to go in half with you, since there was an obvious miscommunication/error with their billing office's estimate.
I've worked in the past at a hospital and unfortunately this happens all the time. We make it very clear to the patients that its up to them to verify their benefits. Once the claim is submitted diagnosis, test etc could be different then what was originally anticipated (although with speech therapy I doubt that's what happened), and then copays/coinsurance/deductibles can change.
Hoping their office will be willing to work with you for your sake! Good Luck
Well, i work at a hospital and work with insurance daily. It pretty much sounds like the girl you spoke to assumed you were "in network" and gave you the wrong benefits. You always need to double check with your insurance provider - as you don't know how well 'trained' the staff at the office is - espeically since contracts are not only based on the name of the insurance company - but by certain products/plans (i.e., hmo, ppo, aso, etc) that company carriers. Different reimbursement on different plans are common, therefore, not all doctors/hospital will contract with all products/plans if the reimbursement isn't worth it.
Yes, I have been in a similar situation and while it's water under the bridge, I have to say I learned my lesson a long time ago. You should ALWAYS call your insurance company yourself before you start a new provider or anything. I'm not scolding you because it isn't the way things usually work, or seem to work but it's just the way they end up working. Sometimes, I call them twice.
This is a really sticky and tricky situation. I would call the therapist directly and tell her what happened. Tell her how much you appreciate what she did for your son, and that this isn't about not paying for the services. Ask her what she thinks can/should be done.
I think in this scenario a write-down of the bill is appropriate...generally offices offer a significantly discounted cash-pay option. Insurance rates are astronomical and even if you take the 30.00 discount, they are obligated to charge you the insurance rate which can be as much as 3x's higher than the cash pay option.
Either way, you are likely going to have to pay much more than you anticipated. I'm so sorry.
This is more for mama, not mommy.
School districts might provide speech therapy, but only if the child falls well outside of the norm. If a child can benefit from speech therapy but their speech isn't _quite_ bad enough for the school district to provide services, then you'd have to take them to a private practice.
And, even if the school provides services, most will try to recoup costs through insurance.
Hi. I work in health insurance and have a couple of suggestions. First I would start off calling the insurance company to make sure that 1) the provider is not a part of the network (could be submitting wrong by the billing department) and 2) that the benefits have been applied correctly for an out of network provider.
If you find that the claims have been processed correctly then wait until you get a bill from the therapist. Once you have the bill in hand then send them a letter (certified return receipt) outlining that when you made the first appointment you were told that your financial responsibility was a $30 copay. You do not understand why they are now balance billing you at this point. Let them know that you were lead to believe they were a participating provider and if they had told you they were out of network you would have chosen another provider for the service.
They may offer you a discount on the services however the doctor's office does not have to do anything. Complaining to the Department of Insurance as mention by someone else isn't really the way to go since it's not something the insurance company screwed up; it's misinformation from the provider's office.
If you are left holding the bag on the bill then yes you are obligated to pay it. I was in the same position years ago and I made sure I sent a payment of $3.00 each and every month to the dr's office. Yes $3 on a $500 bill (long story but totally justified on my part). They can not send you to collections if you are making payments and since you did not plan on this expense then small payments are all you are able to make. In my case after 4 months the dr's office sent me a letter telling me by billing was paid in full. Guess it cost too much in book keeping.
If you need any further info please feel free to message me.
Always call the insurance company to confirm what the office says. Thing is legally they will say you had your insurance company's number on the back of the card, accurate information was yours for the asking and you didn't ask.
You are responsible for the bill.
Still as other have pointed out there is no harm in calling the billing office. Even though you are responsible they usually try to meet somewhere in the middle so they get paid some of the money.
Not quite the same situation but....
The doctor's office for my older son submitted a claim incorrectly 2 times. Well, once they finally submitted it correctly, the insurance refused to pay it because it was too old. This took over a year so it was pretty old. The office sent me the billl since I am responsible if the insurance does not pay. I was able to speak to the billing department and they waived the billing since it was their error. Maybe if you write a letter to the billing telling them the info and explaining that you would have found a more affordable option they will let you just pay the quoted rate or at least a discounted one. I would not state though that the insurance lady screwed up though.
Your state government will have an Insurance Commissioner or Department of Insurance. Go on their website and do some reading. Usually there's a complaint process or an advice section that might give you some guidance as to how you can resolve this.
I hope you can get copies of your checks, any receipts they gave you, any paperwork that you signed. Save it all.
I'm not saying you should sue them or not pay at all, but maybe by speaking to the insurance company and by researching your state Insurance Commissioner site, you might be able to come up with an agreement that more closely matches what you originally planned to pay.
And another reason I happy to have moved to Canada where ALL children are treated fairly and equally. I love an insurance system where they look at taking care of it's youngest citizens as an investment in their future, and not just a way to gouge Mom and Dad.
I am very sorry for your insurance problems. They are rampant EVERYWHERE. I was hit by a car and paid over $30K in co-pays and items not covered after the office lady told me they were covrered.
Can you go back to the insurance lady and get copies of those records to prove what she reported to you?
It taking so long to get the insurance claim and bill back is not unusual, I still am getting bills for my sons surgery back in November. I would call there billing office and see if there was an agreed on amount between the therapist and your insurance company for the visit that they charge. Each insurance company has set amounts that the providers can charge. Insurance then will only cover so much of that amount and you have to pay the rest. The $30 might be 30% of the visit after your deductible has been meet, so that is why the receptionist said that. Also being said, my insurance company doesn't expect me to pay the full deductible at first. Every time I see the doctor I will pay more then my % of coverage, once my deductible is meet then I will only pay my % of coverage. You may not have to pay the full $870 but a lesser price. If you really do end up holding the bag for the full cost, I would make sure a $30 discount was applied and make payment plans.
Argue with your insurance as much as you can and appeal as much as you can. You went along with it based on information you were given. Perhaps you should have looked it up yourself with your insurance (not sure how easy that is for your insurance plan), but you trusted what the doctor told you and that's reasonable.
I work in a medical office and have been given the wrong information by the insurance company countless times. It sucks for the office and the patient. What you can do for the future is call yourself and if you are given the wrong information by the insurance company, most times they will stand by what you have been told (happened to me and some of my patients.)
What can you do if the insurance company will not pay? I would call the medical office and ask for a discount and payment arrangements.
I do medical billing and it always comes down to the fact that the patient and insured is responsible for knowing what their benefits are and if the provider is in network. Because they gave you the wrong information you may want to see if they're willing to cut you a deal or let you make payments. Insurance reps often give wrong information, but that is mentioned in their standard disclaimer. Depending on the company, providers have 3-12 months to submit a claim, and it often takes up to 3 months to have claims fully processed. Sorry!
Find out from your insurance how they submitted the claim that made it process differently. Then give that in writing to the office so they can rebill it with the corrections! If it gets them more money too, I'm sure they will be happy to do so! And to keep you happy of course as well.
I can't believe you're paying for speech therapy at all! We just got "in the system" to have my daughter start speech therapy and it is covered 100% by the public school system (even the transportation, if we decide to have her bussed from daycare to the school)! Is this just a state/regional thing, I assumed that all public schools would provide this service--it's under the umbrella of "special education."
Besides that, I hear you about the PITA insurance stuff! We finally just settled a billing dispute from a doctor's visit 2 YEARS ago! It was this whole confusion of primary vs. secondary insurance. Anyways, the doctor's office is still hoding onto our refund, though, since there are "recent transactions" pending on our account... I think that once we get this all squared away (and we get our money back) we will just find a NEW doctor where they file primary AND secondary insurances!
I know that I wasn't any help, but Good luck!
