Chiropractor not on insurance, sent bills for copay - Updated with resolution!

[Golgatha]

Update 3/15 - Had a nice conversation with the doctor. With the insurance rejections, my final bill would have been closer to $1,100 at the end of the day, which I knew going into the conversation. I ended up working out a cash, paid in full deal with him for the copays he already received ($60) + an additional $420, for a total out of pocket of $480. I got a signed receipt with paid in full hand written by the doctor on it.

I also negotiated a discounted cash deal for future services at $200 for visits purchased in blocks of 7 visits, which is less than $9 over my regular copay of $20 per visit. I really think we negotiated a win-win solution to this issue and I'm just glad this is finalized. Lesson learned and thankfully it turned out well for everyone involved.


Here's my situation. My wife has been getting chiropractic work since September, had a referral from her PCP, and the chiropractic office told her they took our insurance. They've been billing her for the standard $20 copay since then. I received a bill from them this month for $783. On the bill there are 3 different attempts to run the insurance, they were all denied, and put back on the bill. The bill also shows the $20 credits my wife paid at the office or by mail. I called my insurance company to see what's up. They told me the practice seeing her is out of network and there is no coverage. The insurance company also confirmed the attempts to run the insurance and the subsequent denials.

What recourse do I have, if any, outside of talking with them to get the bill to a manageable level, paying it in full and copying the State AG, BBB, etc, or taking them to small claims court for fraud?

My plan is to talk with them today to work it out. If that doesn't work, I'll send the payment in full with a letter (certified mail) explaining that if they cash the check, they acknowledge the statements contained with the accompanying letter. I figure I would put these points in the letter.

1) My insurance was denied 3 times over the last five months and my wife and I were not notified.

2) My wife would not have agreed to the treatment if she had known the insurance was not valid.

3) My wife was verbally told our insurance was accepted on the first visit and was billed at the copay rate for services over a 5 month period.

4) Statement that they were unwilling to adjust the bill despite the aforementioned statements above.

Any other course of action you all would recommend?


Cliffs:

* Wife treated by Chiropractor.
* Told insurance was taken there.
* Claims were denied without us knowing for 5 months.
* Need advice on how to follow up if they're not willing to adjust the bill.

P.S. Please keep the thread on topic. I know a lot of people don't think chiropractic work is real medicine, but it has helped my wife over the years quite a bit. I'm not questioning the work done, just the financial aspects of this business transaction and how I cannot get screwed out of several hundred dollars.

 

[Newbian]

So did you not sign anything showing it was going to be covered or just take some secretaries word for it?

Granted someone should had told you after the first time it was rejected and not wait for so long.

 

[OutHouse]

Called my insurance company to see what's up, and they tell me the practice seeing her is out of network and there is no coverage.

you sould have check that before you even went the first time. when i see a new doc that is the first thing I ask both the doc AND THE INSURANCE company. "Do you take BlueCross"? "do you take insurance claims from dr. so and so"

I know bluecross has a webpage to look up docs and it will say if they are in network or out of network.



you are screwed and need to pay the bill.

 

[Golgatha]

you sould have check that before you even went the first time. when i see a new doc that is the first thing I ask both the doc AND THE INSURANCE company. "Do you take BlueCross"? "do you take insurance claims from dr. so and so"



you are screwed and need to pay the bill.

I admit, in hindsight we should have confirmed coverage with the insurance company, and we won't make that mistake again. I do think the facts that they told her the insurance was accepted, and the bills for our standard $20 copay spanning 5 months are pretty suspicious though. At best this is a lack of communication and at worst they just didn't care and kept billing. Either way, unless they're willing to adjust the bill, I'm going to be pretty pissed and will do everything legally in my power to make their life a living hell as a follow up; even if that just means wasting their time with BBB follow ups, Missouri AG letters, appearing in small claims court, etc. Basically I intend to eat into every bit of the profit they made on my $783 bill as much as humanly possible if they're not willing to work with me.

 

[OutHouse]

I admit, in hindsight we should have confirmed coverage with the insurance company, and we won't make that mistake again.

ive put myself in a few unpleasant situations myself and in hindsight that were totally preventable. like you i never made those mistakes again or similar ones.

i do agree with you, the chiropractors did some shady shit. they knew they were out of network for your insurance the second they copied your insurance card.

 

[waggy]

And people wonder why Chiropractors have a bad reputation?

This sucks OP.

 

[kranky]

I would approach it this way:

"When we first came to your office we were told you could take our insurance as an in-network provider, and that is why we chose to be treated here. Now we come to find out your office is an out-of-network provider and our insurance won't cover her treatment. I understand that mistakes can happen. But it is unfair to learn 5 months later that we are expected to pay the full charges.

I feel it would be fair for each of us to make concessions to clear up this balance. I could have verified you were in-network instead of taking your office's word for it. I'll pay $200 as payment in full for the balance, and of course I have paid the $20 co-pay for each visit already."

If they balk, THEN bring up the fact they ran your insurance three times and failed to notify you it was declined immediately, and you could have resolved this months ago without such a large liability. They could have minimized the problem but did not.

 

[FoBoT]

most insurance companies have some type of appeal process, try that, but you'll probably end up having to pay it all. talk to the chiropractor about a payment plan. good luck

 

[lxskllr]

And people wonder why Chiropractors have a bad reputation?

This sucks OP.

That could have happened to any doctor. Offices drop in and out of networks constantly. I'd try talking to them, and seeing if you can get the bill cut.

 

[OutHouse]

do what kranky says. thats good advice.

remember be nice, dont approach them like a raving pissed off lunatic.

 

[waggy]

That could have happened to any doctor. Offices drop in and out of networks constantly. I'd try talking to them, and seeing if you can get the bill cut.

yes it could have. Again the guy went 5 months and insurance denied 3 times without notification. the few times my insurance has been denied i got a letter fast. Then a phone call cleared it up the one time insurance wouldn't do anything the Doctor gave a HUGE discount (it's amazing how much they charge insurance..)

Chiropractor's have a bad reputation of being fakes or scam artist. Shit like this does not help.

 

[SirStev0]

I see this constantly all day long and it is one of the biggest problems with the "for-profit" insurance system.

Good luck but you are probably fucked.

 

[LurkerPrime]

This is a good reason not to have insurance that only lets you see "in-network" doctors.

On another note, you asked the office if they accept your insurance and they said they did. They even believed they did, since they tried billing your insurance multiple times and only charged you a co-pay. So it doesn't sound like they intentionally lied to you. They are just stupid.

I would call your insurance and see if you can convince them to pay what they would have paid to an in-network provider at the very least. That way you will only have to cover the difference.

 

[DCal430]

I see this constantly all day long and it is one of the biggest problems with the "for-profit" insurance system.

Good luck but you are probably fucked.

I am not a fan of these private medical insurance companies at all because of stuff like this, but aren't most insurance companies non-profit organizations. I know my insurance company Blue Shield is listed as a non-profit organization.

 

[airdata]

One of the objectives of insurance companies is to not pay on claims. Perhaps they're treating the chiropractor as a non medical affair.

 

[Golgatha]

do what kranky says. thats good advice.

remember be nice, dont approach them like a raving pissed off lunatic.

I plan to be calm unless they are unwilling to adjust the amount. I'll be calm when I leave. I'll be ruthless and vindictive in my pursuit of a positive resolution to this matter.

Legally speaking, I think I have a leg to stand on in small claims court claiming fraud.


Elements of Fraud

While different jurisdictions may have their own definitions, under common law in the United States, fraud includes the following elements:

a representation, or statement, of fact;
the falsity of that representation — the statement must be untrue;
the statement must be material, meaning that it is important or relevant;
the speaker must know the statement is false;
the speaker intends the statement to be relied on;
the hearer does not know the statement is not true;
the hearer relies on the truth of the statement to make a decision;
the hearer's right to rely on the statement — the hearer has no reason to think the statement might not be true; and
the hearer must suffer some kind of damages.

 

[Golgatha]

One of the objectives of insurance companies is to not pay on claims. Perhaps they're treating the chiropractor as a non medical affair.

No, I confirmed with them that he's an out of network provider. His office has no contract with my insurance company at all.

 

[Golgatha]

This is a good reason not to have insurance that only lets you see "in-network" doctors.

On another note, you asked the office if they accept your insurance and they said they did. They even believed they did, since they tried billing your insurance multiple times and only charged you a co-pay. So it doesn't sound like they intentionally lied to you. They are just stupid.

I would call your insurance and see if you can convince them to pay what they would have paid to an in-network provider at the very least. That way you will only have to cover the difference.

Uh, no. They billed it 3 separate times and it bounced back immediately according to their own billing records and also according to my insurance company. They knew since October we'd be paying full cash price and said nothing (according to my wife), all the while billing my wife for the standard $20 copay.

 

[alent1234]

i bet you had to fill out paperwork where you listed your insurance and the number. this means they had to know that you weren't covered.

send a friendly email to your state's AG office

 

[Golgatha]

ive put myself in a few unpleasant situations myself and in hindsight that were totally preventable. like you i never made those mistakes again or similar ones.

i do agree with you, the chiropractors did some shady shit. they knew they were out of network for your insurance the second they copied your insurance card.

To be fair, I actually didn't know my wife was referred again to a Chiropractor. She paid those bills herself. I'm just dealing with the aftermath at this point and trying to still find out all the facts. If my wife dropped the ball somewhere, I'll just pay the bill in full and be done with it. We have the money, so that's not the issue, it's the potential principle of the thing that's got me all up in arms at this point. I'll post back later this evening and let everyone know how my talk with them went. I'm going by there before they close after work today.

 

[Golgatha]

I would call your insurance and see if you can convince them to pay what they would have paid to an in-network provider at the very least. That way you will only have to cover the difference.

I did ask this question as well. She had a referral from her PCP, so the procedures are covered (and have been covered in the past as well), but she has to go to an in-network office. This is unfortunately not going to be covered under insurance at all, no matter how many times I might ask. I also believe the insurance company did nothing wrong.

I'd be perfectly fine with the Chiropractor charging me the cash price for services, IF (big if) they had notified me the first time they ran the insurance, so we could have found an in-network provider, and my wife could have stopped seeing the doctor at that point, which would have avoided such a big bill.

 

[DCal430]

I should also point out a good insurance company will not cover pseudo-medicine like Chiropractic, which has more merit than homeopathic "medicine".

 

[MovingTarget]

And people wonder why Chiropractors have a bad reputation?

This sucks OP.

This type of behavior has nothing to do with chiropractic. I've seen similar situations with doctors, specialists, pharmacists, labs, etc. over the years. Our insurance system for medical care is pretty screwed up, and has been for a long time.

 

[DAGTA]

Verifying insurance coverage is the responsibility of the patient, not the doctor. That was your mistake.

Their mistake was not notifying you the first or second time the insurance claim was rejected. I suggest speaking to the office manager and see if you can work out a lower balance on the bill, and then pay it.

After that, it's up your wife and you to decide if you feel the benefits are worth paying cash without insurance coverage going forward.

 

[MovingTarget]

I should also point out a good insurance company will not cover pseudo-medicine like Chiropractic, which has more merit than homeopathic "medicine".

Most insurance companies, including Blue Cross, cover chiropractic....and for good reason. Take your anti-chiropractic trolling elsewhere. This thread is about medical billing in a chiropractic office.