I took my son to the ER on 7/30/05. I got two bills, one from the hospital and one from the ER doctors. I paid the full hospital bill via my deductible. The ER doctor's bill was $130. My EOB shows the following breakdown: $64.50 negotiated provider discount, $15 copay, and $50.50 paid to the doctor. Now the ER doctor is coming after me.

It clearly states in my contract that anyone under the umbrella of a hospital....specifically stating ER doctors....will be paid under the In-network negotiated rates.

When a hospital signs on to be a provider for my insurance company they have to agree to those rates. Otherwise, the anesthesiologist and ER docs could charge $1,000,000 a piece.

Now, despite arguing with them they claim that since the ER docs are not part of my network they don't have to accept the network's negotiated price. So they have turned me over to collections.

I paid my $15 co-pay per my contract and that is all that I am paying. It sounds to me like the hospital and the doctor's group have a problem of some sort. Both my insurance company and I have paid our parts.

Anyone with experience in this?

OC9

I've fought similar situations. It's awful when billing departments are wrong and you have to make dozens of calls to get everything taken care of.

You should call customer service of your insurance company. Most insurance customer service reps will take care of bills like this for you. They'll call the hospital/provider and straighten it out.

Some plans don't offer benefits through the ER, but if you received an EOB stating that the ER/doctor must write off the non-covered amounts (and you're not liable), then obviously the benefits are covered.

OC9: I have had this done three times over the years and we have BC too. What I have done is make a copy of their bill and write "you were paid as per your contracted fee. I have paid my co-pay and don't owe anything further". All the times I did this, I have not heard another word from the doctors. You might also tell them to contact the insurance company, if they feel an error has been made. Make sure you tell them you have paid your co-pay.

Thanks folks!

I sent a copy of the bill, the collection letter, and a letter explaining it all to the collection agency. I explained that I didn't owe the debt and that they weren't to ding my credit over it.

I have my insurance company looking at it....they act like they are going through an act of congress to get it paid. However, their on-hold message says clearly "if you receive a bill for the negotiated provider disount, write the policy holder's name on the bill and send it to us....we'll take care of it". Damned insurance companies.

Just for good measure, I sent a complaint to the Georgia Insurance Commissioner's Office and they have an investigator looking into it.

OC9

OC9: Obviously you know the situation better than I do, but I think you might be going at it a little different than you should. Your situation has gone further than any of mine ever did. I nipped them all in the bud, when I got that first bill from the provider.

As I said earlier, send a copy of their bill, a copy of the EOB with I don't owe you anything more as I have paid my co-pay and that should be the end of it. I never heard another word from them after doing that when I first got the bill that I shouldn't have gotten. It may be tough to get off your financial record (credit report), if it ever gets on there. The insurance company isn't to blame, it's the provider. I got a bill once from a surgeon who did a minor surgical procedure on me. He wanted over $230 more that Blue Cross didn't pay because it exceeded his contracted amount. I sent his bill and the EOB back and told him I didn't owe him anything and never heard from him again.

Good luck, I hope you get this settled.

Director,

Well, yes and no.

When I originally got the bill, I ignored it because of delays paying at the insurance company. When I received the pre-collection notice, I took note and called the physician's office. They were very rude and said that since they are not in network there is absolutely no way they would honor the discount. My benefits administrator at work said "sometimes that happens and while we will try on your behalf, sometimes there isn't anything we can do about it (we being the insurance company or my employer).

However, on the insurance company's on-hold message it clearly says that if you receive such a bill, forward it to them and they will take care of it. This is the same company that denied my vision exam first because the provider wasn't in network. I explained to them that there is no network, it is a straight indemnity benefit. Then they said "oh, I see what happened, the doctor checked code 14007 and should have checked 14017". I went ballistic and said, ********E, I have the original paperwork in my hand and the right box is checked. "Oh, okay, I will send the check tomorrow morning".

The insurance company is reprocessing it and I am writing my Georgia representatives to ask that they streamline this process. Everyone in the US is bound by contract law, except the insurance company/hospital/doctors in the the hospital. Our insurer's contract with the hospital says that everyone in the hospital will be paid at network rates if it is a network facility. Somehow the hospital doesn't push that down to the doctors it employs.

I also filed a complaint with the Georgia Insurance Commissioner and received a personal letter back stating he was putting an investigator on the case. This should have never come about.

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