- April 26, 2024
- Posted by: legaleseblogger
- Category: Related News
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## Situation with Psychiatrist Billing
I visited a psychiatrist and provided my insurance card up front, but was later sent a $120 bill with the memo “CASH PAY UP FRONT” six months later. When I called to inquire about why my insurance was not billed, I was told I did not present it initially. Despite my efforts to resolve the issue through email communication with the owner for written evidence, I was continuously prompted to call instead. Feeling frustrated, I left a review on Google requesting email correspondence. However, the situation escalated to the point where the debt was sent to collections, and I still refuse to pay it.
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## Update on Insurance Complaint
After reaching out to my insurance to file a complaint, the representative went above and beyond to investigate the situation. It was revealed that the psychiatrist I visited was not in-network, despite previous claims, and had inaccurately checked my coverage on the Medicaid website. This action was deemed illegal under state law, which protects Medicaid patients from being billed when insurance information is provided.
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****** just grabbed a
Was the provider in network? If so, you might be able to complain to both your insurer and your state’s insurance board about what happened. In many cases, the onus is on the provider to do timely filing provided that they’re in network.
If they’re out of network, you likely have no recourse.
>they told me to ‘be an adult and pay it’.
Did they actually say those exact words? That’s REALLY unprofessional.
Former long time medical claims examiner here.
You can send them an itemized bill with all the codes on it (ask your doctor for one) and submit the claim yourself. If the doctor is on their provider panel, they may be contractually obligated to bill insurance, but if they are not, it’s on you to do so.
Call your insurer and ask them what the bill needs to include (likely date of service, cpt/procedure code, diagnosis code, provider name/address/phone/tax id#, patient name/address/dob/member ID number, possibly a claim form but not always).
They will then reimburse you directly if you’ve already paid or if the provider isn’t a contracted provider with them.
As others have said, it’s always ultimately on you to pay, but in the case that this provider is contracted with your insurer, you’ll want to involve provider services. And probably find a new doctor.
Medical debt under $500 is not reported on credit reports as of April 2023. But it for some reason it shows up, you can file a dispute to have it removed.
Medicaid MCO rep here. Call your insurance again. I feel like you may have gotten a bad rep the first time you called. Explain the situation, they may be able to reach out to the provider to resolve the issue or they may have an internal team that’s in-charge of settling disputes with providers. I’d also encourage you to file a grievance against the provider just based on how you said they talked to you. A grievance could also potentially get your bill resolved if it turns out that you’re not actually responsible for the balance. Medicaid coverage varies a ton state-to-state, so I’m trying to keep this very general. Definitely call your insurance again though.
I would just add that if they actually said “be an adult and pay it” it’s time to find a new provider, if you haven’t already.
Write the collection agency IMMEDIATELY and tell them you dispute the validity of the debt and are requesting debt validation pursuant to the FDCPA (Fair Debt Collection Practices ACT). They cannot do anything to your credit without sending you debt validation. If they send you an itemized bill, forward it to your insurance. They should be able to assist. They might not be able to pay the bill since it’s in collections, but they could reimburse you for the amount you pay.
> I visited a psychiatrist and I gave them my insurance card up front. Six month passed before they sent me a $120 bill with the memo “CASH PAY UP FRONT”. I, confused, called and asked why they didn’t bill my insurance. They claimed I did not show it up front, but when I argued I did, they told me to ‘be an adult and pay it’. I proceeded to try and get in contact with the owner, claiming I wanted everything via email to have it in writing and they kept insisting I call to get it figured out, and after repeated emails that I will not be doing this over the phone because I wanted written evidence, they ghosted me. I then wrote a review on the Google page and told them to email me. When I called my insurance, they said their was nothing they could do becuase the bill hadn’t been sent to them. Now the debt had gone to collections, and I still have no intention to pay it. I was told I could write the credit company and they would excuse it, but it there anything else I can do?
why didn’t you pay and then submit your receipts to insurance to be reimbursed?
Medical bills under $500 cannot be reported on credit any more, you can google the law.
Don’t stress, don’t pay it. Move on with your life.
These doctors and clinics stay starting to scam people. There have been countless times where I get a bill but my insurance covers everything 0 deductible on anything no matter what and yet I still get bills. They always use the excuse of an error but there can’t be that many stupid people working in healthcare admin it’s got to be they are trying to see if you a enough of a sucker and or lazy to not fight it.
Seconding the comment made earlier, depending on your state and if your coverage was active on the date of service… I’m in Texas and we are absolutely not allowed to bill Medicaid patients.
>What happened was that the doctor I saw was NOT in network, even though I was told they were (my bad for not verifying through insurance,
As someone from a country with normal healthcare, reading this statement was a huge wtf moment.
If medicaid , put in complaint with them
I have blown off a few small medical bills in my life for a variety of reasons (doctor was awful and useless, should have been in network and wasn’t, etc) and I don’t think I ever heard a single thing about any of them ever again. And that was before the $500 threshold change to impact your credit report from a couple years ago.
I don’t think health related bills hurt your credit anyway
Are you sure that 120 wasn’t a copay? That seems very low for 6 months of therapy.
This is just a paperwork issue. You could submit the claim to insurance. You might have to pay it first and then make the claim. It’s nicer when the doc does it for you, but not required.
It’s professionals being lazy or double dipping. Every time I visit a Dignity urgent care/ER, Dignity bills me correctly, but the doctors never do. Even if the doctors are out of network, it doesn’t cost $600.
Its good that its medicaid. I know of several times people with private insurance who reported fraud to their insurance company and it wasnt acted upon. I always wondered why they werent concerned and I stumbled across this story recently and it all made sense:
https://www.propublica.org/article/health-insurers-make-it-easy-for-scammers-to-steal-millions-who-pays-you
TL;DR: private health insurance ignores most insurance fraud because its easier to not investigate and pass the cost on to consumers. Medicare and medicaid have an actual incentive to pursue it because of limited funds and prosecutors look good going after it.
Holy cow your insurance stepped up to bat for you and actually helped you. That never happens!
I do believe that recent changes have made medical debt less than $500 NOT to show up on your credit report.
“Technically” illegal is just illegal. They broke the law. They can suck eggs.
Isn’t ironic that you sought a little mental health care and the result is a huge hostile headache?
Every state should establish a system enabling individuals to report medical offices or practitioners in cases of billing discrepancies or potential fraud. If you’ve exhausted all efforts to resolve the issue directly and they remain uncooperative, filing a formal complaint is the next step.
I’m glad this worked out for you. I am always baffled by these stories because my background is in pharmacy (thankfully I’m not in retail anymore but I spent years there) where like 50% of our time every day was spent trying to get stuff covered through insurance for people.
It’s just part of healthcare, unfortunately, and therefore part of the job of taking care of the patient. I can never understand why I see so many provider’s offices seem to bend over backwards to fail at dealing with this very crucial step in providing medical care. It’s such a shame.
Dispute the debt with the credit reporting agencies. Complain to the doctor about their office staff. Complain to your insurance carrier that the in-network doctor wouldn’t submit your claims. Pay the bill and claim reimbursement from your insurance.
Your state should have a way to report a medical office or practitioner for billing issues/fraud. If you’ve done everything in your power to straighten out it and they refuse to work with you, submit a complaint.
Laws and contracts differ, but in general *you* are responsible for services provided to you. Most practices bill your insurance as a courtesy, but you’re ultimately responsible.
This is worth remember on the auto side too. I see posts where people say “the insurance company of the guy who hit me wouldn’t pay for anything”, well then you call the guy directly. His insurance company doesn’t owe anything to you directly, they owe the guy indemnification for damages he causes.
So… this is your responsibility to pay the psychiatrist and – if covered- it’s your insurance company’s responsibility to reimburse you.
I had a similar thing happen to me. I had been to an eye doctor a few times while i was on Medicaid. By the last visit, they dropped Medicaid as an insurer but didn’t inform me. In the Medicaid regulations handbook (or state regulations, i can’t remember but it’s like a 500 page book of the rules), it explicitly states that it is the provider’s responsibility to inform patient that they do not accept Medicaid prior to delivering service. They never told me that, because if they had, there’s no way i would’ve gone to there, i would’ve just found another practice.
Anyway, once I got a job, it alerted something in their system and they tried to send me a bill and harass me over it. I sent them a letter back saying i was covered under Medicaid at the time and they needed to bill Medicaid (which they didn’t and it had already passed their timely billing requirement). I enclosed all the necessary information in the letter in case they ever decided to come after me, kept a copy of it, and basically told them to fuck off. They continued to send me a few bills, but i eventually stopped getting them. I preemptively spoke with a lawyer and he said I could not sue them until I had damages (e.g. they reported it to my credit, which they never did). Even though the amount was only around $100 and i could’ve easily paid it, I refused to pay it on principle. Fuck these people, they should follow the law!
Edit: I found the guidebook. It is my state’s billing manual for medicaid providers. I am sure your state has something similar, with a similar provision. It is a clear as day. Also, you might want to speak with an attorney as you have actual damages you can sue over. I just hate to see vulnerable people fucked over so when the opportunity comes to stab a knife in corporations side I’m happy to do it.
First of all, really happy to hear this is being handled.
> What happened was that the doctor I saw was NOT in network, even though I was told they were.
Shit like this is why our healthcare system is so frustrating. It’s gotten so complex to the point where providers don’t often know what they charge and whether or not they’re in network! Individual parts of an episode of care could be excluded (think anesthesiologist) through no fault of your own, even if you went to in network hospital for care.
I’ve got one of these too where they said they were in network , think it can’t go in credit report if under $500
Some providers don’t want to deal with insurance companies, especially if they are not in their network. All you needed to do was file a claim directly with the insurance company and they would have refunded you for any amount they are responsible for.
Call the local news station and ask them to help you and make a story out of it
Wait for it to fall off your credit report. It’s only $120 and should affect your credit score because of new laws about unpaid medical bills under $5k having no impact.
I think I’d pay 120$ to be done with both this doctors office and any potential future collections personally
what the have is $120 in unsecured consumer debt. Filing in small claims would cost them about that amount. Now that it is with a debt collector, even if you paid it they would probably only receive about 1/2 the amount. Providers have contracts to accept insurance payments… not sure that all works, but it should come into play.
I had this issue because someone hit me with their car. And then their insurance refused to pay my hospital bill for OVER A YEAR. Call the agency and tell them you’re not he responsible and will not be paying. Then, fuck them, don’t answer and don’t give them the time of day. You’re innocent. And if they come after your credit, you dispute that shit IMMEDIATELY.
Yet another person posting that they went months without getting an EOB from their insurance company yet assumed that the bill was paid. Does a week go by here without a post just like this?
Yes, your doctor was remiss. But so were you, and you the one who ultimately owes the money. Your responsibility is not complete when you give them your insurance info. If you don’t receive notification that your claims are being filed and processed, you have to follow up and find out why. And when you do receive the notifications, you have to review them and make sure they’re correct. There are time limits. The longer you let things go the harder it is to get things straightened out.
Pay the bill and move on with life.
sorry but you received a service, so why shouldn’t you be responsible for payment?
If you have an agreement with an insurance carrier, then you can contact them and have them pay the bill. But that’s on you.