Psychologist/Insurance issue and collections..

[FLPrincess82]

Last July I saw a psychologist (insured). I had a lot of insurance bills and some I overpaid so I got a check in March for this from my insurance company, which was typical. I overpaid a lot of bills. This particular doctor harmed me. I had a panic attack in his office, and he was asking me for my copayment while I was shaking like a leaf.

Fast forward to now. I received a check. Apparently, according to his email today, he said I was overpaid and the check should have gone to him. Annoyed as this doctor was terrible to me, I just emailed him back don't email me. So he left me a voicemail 2 minutes later saying if I didn't pay him in a month he'd send me to collections.

I haven't gotten a statement from him. I hate him. Does he have to send me an invoice before sending me to collections?

[justbroke]

If you reasonably request a statement or invoice showing the amount owed, the doctor "must" comply. You can ask for such statement or validation as part of the Florida Deceptive and Unfair Trade Practices Act (FDUTPA). You may want to mention the FDUTPA to the doctor and kindly remind the doctor that you were never invoiced. Also, if you were treated by the doctor, then the doctor earned their fee and you can't simply withhold their fee because you didn't like the outcome. As you know, that fee is earned even if you don't like how the service was rendered.

(Medical malpractice is a totally different story but I did not read anything about any claims of malpractice.)

I personally know that there are patients that have trouble with their psychologists and that these patients sometimes will just be annoyed with a particular practitioner (and in extreme cases, just about every practitioner). The key is that you will need to remain professional and ask for the billing. The doctor should be compensated for his/her time, but if you see a misbilling (they charged you 2 hours for a 1 hour session), then you should dispute such. Otherwise, just chalk it up to the fact that this particular practitioner did not mesh with you, pay the bill, and move on.

[ksgirl38]

I apologize if this appears to be hijacking the thread, but Justbroke I saw what you posted about the doctor has to provide a statement and it brought up some questions.

Last August I saw a new doctor to evaluate an ongoing thyroid problem. The doctor is housed in a local hospital and I had blood work done there also on the same visit. Apparently the blood work was billed separately under the hospital's name. The doctor is also part of the hospital. Well I got a few things in the mail from the insurance company saying they received my claim, blah, blah, blah. I pretty much ignored them knowing that they were still processing everything and if I did owe a copayment or anything then I'd probably get a bill for $30 or so later.

Maybe six weeks after the appointment I ended up getting a check from the insurance company. Apparently I had really crappy insurance and for some reason there's a small part on the claim form where if the doctor doesn't indicate they want the payment sent to them it's sent to the patient instead. I only found this out from my eye doctor who I had seen around the same time and called me when they didn't get a payment from the insurance company and I had a check show up made out to me for the same amount. Anyway, I ended up writing a check to the doctor's office (for the thyroid evaluation) for the amount of the check that was issued to me and sending it to them. Well maybe a month later I get another bill from the doctor's office. I assumed it was an error and maybe my check and their bill crossed in the mail so I ignored it. Then I got the second bill about a month later. That's when I got out all the paperwork I had gotten in the mail and filed away and reviewed it to find out that my insurance didn't cover everything and I still owed. $125 seemed kind of high for a doctors visit, but I knew it wasn't great coverage anyway. Since I had blood work done also I thought maybe that was part of what I owed. I don't think I'll ever understand how insurance works. Well after I paid the $125 I got another bill for the same amount. Again I assumed the check and bill crossed in the mail so I pretty much ignored it. A month later another bill showed up. On all the bills I received from the doctor's office it never outlined what I was paying for. No statement of services. By this point it's December and thinking I paid everything I sent their bill back with a post it on it stating basically that they needed to send me a detailed statement - no statement = no payment. I got a statement from them in January. Well that's when I discovered that although I had been receiving bills on the same letterhead they hadn't combined all the charges onto the same account. They had two separate accounts for me. One for the doctors visit and a separate account for blood work. I don't know if that's normal or not since the hospital did the actual blood work and the doctor is part of the hospital, but it was the same billing address and I assumed the same billing department. Anyway, after I discovered all this I realized I did owe another $125 and mailed it to them. So now we're into February when the check cleared my account. Then last week I get a collection notice in the mail. I double checked my bank account and my last check was cashed on February 26th and it appears that the collection letter was issued on March 5th. I guess my question here is how can a hospital, or doctor's office, send you to collections when they failed to provide a detailed statement of services straight from the beginning? The only way I know what was charged to the insurance company was due to the letters I got from the insurance company showing what was billed to them with a notification on it that they received the claim and not to pay, that it was just a notification. I ended up paying out about $500 which I still think is high for someone who had insurance, but maybe I've just always had better insurance and never realized how much it actually costs. I sent the collection letter back with a copy of the cleared check from my bank account. I can't imagine I owe any more, but I'm still rather annoyed that I had to actually ask for a statement of the charges.

[justbroke]

When insurance is involved, the provider should follow some simple process. (Note, I have done consulting in medical claims and insurance claims processing, but I don't endorse this as the process that a provider should or does perform. It is just what makes sense to me!) The provider should validate the insurance is active, that the patient is covered, and get an initial authorization. The provider should collect any co-pay at time of service (either based on what's on the medical insurance card or based on the initial authorization from the insurer). The provider should then send the claim to the insurer. When the insurer responds, the provider should reconcile what the insurer covers and what the Insurer states is the patient's responsibility. At this point, the provider should provide a billing (detailed) to the patient.

I like how my insurer now allows us to see what was exactly charged, the diagnostic codes, what was billed, what was the negotiated rate, what the insurer paid, and what I owe... all online! I can also pay online the uncovered costs. My insurer allows us to receive a Statement of Benefits (SOB) either electronically or in the mail. I choose the electronic version since I can see what's going on. I can always see the status of all claims in the last 18 months online as well. It is very helpful.

If your question is more about what is considered "detailed" or a statement of services performed, then that's more a technicality. If the doctor simply bills you and it reads "Office Visit, not covered by insurance... $125.00", that should be enough. If your insurance didn't cover the right amount, you would contact the insurance company first to determine what's wrong. Sometimes, it's just that the doctor used the wrong diagnostic code! (Happened to me recently where I received a $916 bill because the doctor mis-coded the service. This was corrected and was a 100% covered service!)

Unfortunately, mis-codes and other issues do happen. I had a procedure done, minor surgery, where I received 4 different bills! I double checked my coverage because it did cost me, out of pocket, almost $1,600 (with $6K being covered). I thought it should cover more, but elective surgery is 80% covered.

[AngelinaCat]

Since this is an insurance related thread, I am moving this to the Insurance Board.