michael Killacky
Pre-takeoff checklist
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- Feb 23, 2005
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mikek
I've got a quick quenstion on Health Insurance and participating providers.
A little background: My wife had eye surgery for macular degeneration in July of 08. She nows goes to the same doctor every 6 weeks for an injection in the eyeball. One of the meds used in July of 08 costs $1349. Due to a miscommunication between the insurance company and the Drs. Office, only $11.08 was paid towards the bill. The surgery itself and all other meds used were paid in full. Now, the Drs. office has called me and put me in the middle to sort it out with the Ins. Co.. The Ins Co. says that the claim was not filed correctly and told me what had to be done to resolve it. I relayed this info to the Dr. Staff and told the Billing Girl it would probably be best if she called them herself. Her quote to me was " I'm not calling them, I'll get some Indian I don't understand and that irritates me." She refiled it without calling them, and it was again denied.
I opened an inquiry with my Ins. Co. on Monday. Because an Inquiry was opened, the Ins. Co. won't talk to the Drs. Office until there is a resolution.
The Dr. Office called me today and said that they will not see her as scheduled today unless we pay 1/2 of the outstanding bill.
I firmly believe the Drs. Office bobbled the first claim and the insurance company has bobbled the 2nd claim.
My questions are:
1) Can the Doctor call himself a participating provider given the story above?
2) What would you do to resolve this?
I'm in NYS if tht makes a difference
Thanks, Mike
A little background: My wife had eye surgery for macular degeneration in July of 08. She nows goes to the same doctor every 6 weeks for an injection in the eyeball. One of the meds used in July of 08 costs $1349. Due to a miscommunication between the insurance company and the Drs. Office, only $11.08 was paid towards the bill. The surgery itself and all other meds used were paid in full. Now, the Drs. office has called me and put me in the middle to sort it out with the Ins. Co.. The Ins Co. says that the claim was not filed correctly and told me what had to be done to resolve it. I relayed this info to the Dr. Staff and told the Billing Girl it would probably be best if she called them herself. Her quote to me was " I'm not calling them, I'll get some Indian I don't understand and that irritates me." She refiled it without calling them, and it was again denied.
I opened an inquiry with my Ins. Co. on Monday. Because an Inquiry was opened, the Ins. Co. won't talk to the Drs. Office until there is a resolution.
The Dr. Office called me today and said that they will not see her as scheduled today unless we pay 1/2 of the outstanding bill.
I firmly believe the Drs. Office bobbled the first claim and the insurance company has bobbled the 2nd claim.
My questions are:
1) Can the Doctor call himself a participating provider given the story above?
2) What would you do to resolve this?
I'm in NYS if tht makes a difference
Thanks, Mike
