Advice on getting money back from medical billing

skizzle

New Member
I need a good starting place for get money back from a medical billing office.
Long story short, this place owes me a little over $300. Yes, I paid up front before receiving the Benefits of Explanation. After I received this, I started calculating the costs and couldn't believe how much I over paid. Not once did this billing place contact me. It's like a 3rd party billing company for the provider. I have called my Insurance Company and they claim that they are not able to force the company to pay the money back. I have called the company with numerous voicemails with no call backs. I have even sent them a fax with how I came up with the amount and to call if there was a problem. Been trying to get this money back since mid-March.

So, anyone have problems with this sort of thing or have a suggestion of where to start. TIA
 

vegmom

Bookseller Lady
I need a good starting place for get money back from a medical billing office.
Long story short, this place owes me a little over $300. Yes, I paid up front before receiving the Benefits of Explanation. After I received this, I started calculating the costs and couldn't believe how much I over paid. Not once did this billing place contact me. It's like a 3rd party billing company for the provider. I have called my Insurance Company and they claim that they are not able to force the company to pay the money back. I have called the company with numerous voicemails with no call backs. I have even sent them a fax with how I came up with the amount and to call if there was a problem. Been trying to get this money back since mid-March.

So, anyone have problems with this sort of thing or have a suggestion of where to start. TIA

Have you contacted the provider?
 

Tigerlily

Luvin Life !!!
I work for an insurance company and I am sorry to say there is nothing we can do to make a provider do anything for you. It's is hard enough to get our money back if errors are made. Your issue is with the provider not the billing company. The provider pays the biller to handle that for them. The biller gets a fee for the service but when your insurance company pays the check goes to the provider not the biller. You need to take your eob to the provider and the recipts for your payment and demand to speak with the office manager. You should pay no more than any deductible or coinsurance owed and make sure they do not jack you for the contractual adjustements that you are not liable to pay.
 
D

doubt_me

Guest
sometimes it takes forever, but you will eventually get it back (maybe). being in your shoes, im sure that sounds like crap.

i got my wisdom teeth pulled and paid what i would owe up front. six months later i got a refund of almost $80 because i over paid.
 

Tigerlily

Luvin Life !!!
Honestly If you need any help shoot me a PM. I had an instance today where a doctor's office has been badgering the heck out of us to process charges as secondary. Four calls it took to get the proper EOB and low and behold I got not only the provider's EOB but the participant sent me their copy as well.

To get to the point one of the services was disallowed by the primary carrier as being considered part of the main procedure. The patient's EOB as well as the provider's both clearly stated the patient had zero liabilty, no copay or deduct owed. So why is the provider yelling and screaming at us as a secondary?

Because they want us to pay for a procedure that was deemed not covered by the primary carrier. They were threataning to send an account with nothing due to collections over a contractual obligation. So you have to really be aware of what is going on. So many folks just pay and don't even lknow why.
 

Connellsville

New Member
I need a good starting place for get money back from a medical billing office.
Long story short, this place owes me a little over $300. Yes, I paid up front before receiving the Benefits of Explanation. After I received this, I started calculating the costs and couldn't believe how much I over paid. Not once did this billing place contact me. It's like a 3rd party billing company for the provider. I have called my Insurance Company and they claim that they are not able to force the company to pay the money back. I have called the company with numerous voicemails with no call backs. I have even sent them a fax with how I came up with the amount and to call if there was a problem. Been trying to get this money back since mid-March.

So, anyone have problems with this sort of thing or have a suggestion of where to start. TIA
To the Maryland Attorney General's website (Health Education and Advocacy Unit) Maryland Attorney General - Health Education and Advocacy Unit). This website will give you instructions on filing a complaint. I used them when I had a billing problem with Johns Hopkins last year. They will contact all parties involved until the matter is resolved. I wrote a letter outlining my situation, but you can also file a complaint online. Good luck!
 

browneyes

New Member
BBB from your area will look into any complaints and contact the company.
Bringing attention to them might make them pay up.
 

virgovictoria

Tight Pants and Lipstick
PREMO Member
I work for an insurance company and I am sorry to say there is nothing we can do to make a provider do anything for you. It's is hard enough to get our money back if errors are made. Your issue is with the provider not the billing company. The provider pays the biller to handle that for them. The biller gets a fee for the service but when your insurance company pays the check goes to the provider not the biller. You need to take your eob to the provider and the recipts for your payment and demand to speak with the office manager. You should pay no more than any deductible or coinsurance owed and make sure they do not jack you for the contractual adjustements that you are not liable to pay.

This is correct. In addition, I suggest you mention that IAW (in accordance with) their contract with your insurance company, they are obligated to comply. If they fail or object, then written submittal should be drawn up by you, documented the where, when and why and who you spoke with and have it ready.

At this point, if it gets to this point, which I doubt it will, call your insurance company with your situation. They'll pull up your claim/EOB and most likely place a 3-way call to your provider's office if you call during business hours. Most physician's don't like to get in trouble with insurance companies, regardless of their distaste for them. The phone call should resolve the issue and in most cases, your insurance rep will follow up.

Now, if you still have problems, submit the written complaint and follow the others' advice on local handling procedures.

Usually just contacting the office manager should work. Unless the doc is a real tightwad A-Hole.
 

Tigerlily

Luvin Life !!!
The sad part is that doctors nail it to folks up front that have no insurance first and then to people who are out of network or non contracted second. Third would be a situation like this. The reason being number one would be Medicare prime patients. The amount per service that is allowed by Medicare versus what the Doc would charge is sickening. Also Medicaid polices work the same way. Then the smallest category would be the non insured. If you have no insurance at all they will not even see you at all without geenbacks up front. Unless you are in the ER.
 
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