ongoing billing issues w/ doc...

March 4, 2008 1:00 PM

I'm having ongoing billing issues with a doctor and it's time I seek resolution with a third party. Where should I go?

This is in response to this previously asked question. The situation is still not resolved. Basically, there is a large discrepancy between what the doc charged me and the info he's given me to charge my insurance. I've done pretty much all I can and now it's time to take the matter to the next level. Which would be what, exactly?

posted by keith0718 to law & government (6 comments total)

What actually happened? Did you call him and/or write to him via certified mail? Has he totally ignored you or has he just pushed you off with some sort of excuse? I think some more details would be helpful.
posted by tastybrains at 2:02 PM on March 4, 2008

Do you have an image of the cleared check that you wrote to him?
posted by oaf at 2:10 PM on March 4, 2008

He billed my credit card once a month. There are several session for which he charged me, which he didn't include on the billing information to the insurance. I've emailed him for the past 6 mos. with limited success. The same with certified letters--I've sent two. He ignores all contact for several weeks and then we'll get something in the mail, which is nothing more than the same old wrong information to bill my insurance--missing about $1000 of sessions. I've laid the problem out to him several times in certified letters and emails. It's like he's not trying to understand it, but just sends the same old stuff out again w/o trying to correct it. I can't call him because he doesn't have an "office". He's a tele-counselor and all contact is initiated via message service. I just left my first message for him to call me today. He did! And...somehow...figured the whole thing out by himself on the phone in less than three minutes!!! (And I've been hammering on this for six months.) He promised something in the mail by the end of the week. But I've heard that before. I want to be prepared to take this to whatever gov't agency I need to if he doesn't come through. Who handles these sorts of things?
posted by keith0718 at 2:38 PM on March 4, 2008

The good news about certified letters, is that if you get them back, and they haven't been picked up, you can still prove that he received them, and he'll be treated as though he read them if you have to sue him.
posted by oaf at 2:57 PM on March 4, 2008

Have you tried contacting the insurance company directly and letting them know this is going on? If you have the credit card receipts (or even an online version) that show he has been paid for his services, you should be able to provide those to the insurance company along with copies of your correspondence to help further your claim, but I would speak to an insurance representative over the phone first, because when it comes to insurance claims, procedures matter.
posted by misha at 3:55 PM on March 4, 2008

Given that you have his drafts from your credit card on record (via the billing statements), it might be a good idea to have a little standard paperwork handy for all future efforts in this regard.

Specifically, a side-by-side comparison between the dates he claims he treated you, and the charges he posted to your credit card. Presumably there will be a lot more of the latter dates than the former.

Then you can try a certified letter that shows both of these things, and ask him to either provide paperwork for the additional items (so that you can bill insurance), or you will ask your credit card company to charge back those items (as you shouldn't have been charged if he didn't treat you.)

What I suspect is going on here, however, is that he's lost his records of treating you on those other dates, and he doesn't want to admit it because he knows you'll do a chargeback if he can't prove he treated you. So he perhaps hopes you'll send those dates so that he can retroactively create records based on those billing dates.

So you have a couple of options: take the high road, provide him with those dates, and hope I'm right and he'll use it to generate the information you need to bill insurance...or take the sketchy road and don't provide the dates, and let him know you're contacting your credit card company to have the charges reversed -- to which he'll either deliver the proof, suck it up, or hire a lawyer.

Be sure to tell us what happens.
posted by davejay at 5:56 PM on March 4, 2008