Need advice with unpaid insurance claim

[coffeebean]

What is the name of your state (only U.S. law)? CA

Hi,
I am hoping I can get some advice here since my unpaid charge is going to collection next week according to the office.

On January 15th, 2010, I went to a new doctor, which I had checked upon making appointment they take Cigna Insurance. On the day of appointment I provided my CIgna card, ID, etc.. and paid my copay.

Almost a year later, I started getting invoices from the doctors office for my visit. I have argued that I was insured by Cigna, they said they took Cigna, I paid copay and shouldn't owe anything else.

I came to find out that during my visit, they had a contract gap with Cigna. So they did take Cigna when I made the appointment, the receptionist at day of appointment didn't know they had a contract gap also. A few months later, the doctor's office renewed their contract with Cigna.

So I received wrong information from the office, which took cigna until about a month before my appointment and reinstated it a couple months after. But I went there during the gap.

Cigna doesn't want to pay. I have appealed. And the office keeps charging me for $400.

Do you suggest any other actions I can take to not incur in those charges? WHat else can I try?

Thanks so much

 

[cbg]

Ultimately, you have the bottom line responsibility to provide payment. To protect your credit rating, pay the bill NOW. You can always continue arguing after the fact and, if your argument is found to have merit, accept a refund. But the doctor is entitled to be paid, and the ultimate responsibility is yours.

 

[ajkroy]

In addition to the excellent advice from cbg, you have learned a valuable lesson in all of this: to always check your benefits before incurring a bill. Even though you may think think you have done your due diligence by checking with the doctor, the fact is that the only one who really has that information (as you have just found out ) is the insurance company. Never darken a provider's door without calling them first again.

That said, you can try to negotiate with them and see if they will work with you. Your best bet is to ask if they will take Cigna's negotiated rate (which is what they would have been paid anyway). Keep in mind that they don't have to work with you at all, and they have been waiting for their money for nearly eighteen months.

Remember that you catch more flies with honey.

Good luck.

 

[coffeebean]

Hi,

to avoid collection I have been able to negotiate the charges down and I plan to pay for it. But I would like to know if there is anyway I can still fight for a refund and waive of charges?

They told me they tool cigna when i made the apointment, and they took my card and I paid the copay as they asked me. If I owed them any amount, they should have told me before seeing me. Or at least after.

Thanks

 

[ecmst12]

They didn't know that you would owe money until they got the claim back from your insurance company. That is when they told you.