Possible fraud w/ local business...what would you do???

Okay, I need help in figuring out how to handle this. I go to a local chiropractor, who has done wonders for my health. However, I kept wondering why my copay kept going up. I called BCBS on Friday. I was shocked that not only was he overcharing me, but has NEVER charged me my copay amount of $10. He IS in their network of approved providers. The lady at BCBS is irate as she said this is clearly fraud. She said if he does not give you a full refund, then call her back and she will open a fraud case. Here's teh deal. Been going there for quite awhile. Copay started out at $20 which is usually normal for all our other specialists so I thought it was correct. Then they raised it to $24, then $27, then $30, then $32 and now $36. Signs are posted about the raised copays and eeryone gets a copy when they go up. I'm beyond on a limited budget so this was hard for me. That's actually why I called BCBS in the first place was to make sure that the chiro was allowed to raise the copay on his own. She said NO WAY!!! She even got a supervisor to verify it all. They were both upset. She said essentially, he's taking whatever above $10 you are giving him as BCBS pays the rest. I'm shocked b/c he just doesn't seem like someone who would do this. That's why I asked to double check w/ the supervisor. If this is truly the case, which apparently it is according to BCBS insurance, then this place owes me literally hundreds of dollars. Haven't added it all up yet as I have to go to teh bank to get all my statements. Urghh.

What would you all do? I feel bad b/c I have to bring this up yet feel I deserve my money. I like this chiropractic practice alot however, after this conversation w/ BCBS on Friday, I'm having a different opinion of them. Please advise what you all would do. How would you approach them? Do I say " I was double checking all my insurance coverage and discovered that you are actually charging me the wrong copay amount." I need to get a refund for the back amount so that I can continue to come here. Would that sound okay? Of course, right now I don't even know if I want to go back b/c I feel like I got ripped off.

Opinions and advice would be welcomed. Could the insurance company be wrong? I doubt it as they are such dog gone sticklers for rules--LOL.

Take care,

Stephanie--mom to 7

 

I hate confrontation...don't ya just wish we could all play by the rules?

Can you take your ins card to their office and ask why they are charging more than the normal co-pay? If they have a good reason (in their eyes) ask them to put it in writing.

 

You could try this first since you've been going there and feel like he's helping you. But if they don't come clean, I can recommend Crossroads Chiro, Dr Williams at exit 219. We recently started going to him, he's very nice, really like him alot and with BCBS my co-pay is $20.

 

If that doctor is CONTRACTED with BCBS, which you said the rep from BC said they are, You should ONLY ever pay your copay. NO MORE NO LESS. If the Chiro is listed as a provider they signed a contract with bc.

Me, I would go to the chiro or call and ask for a record for all of your visits. Or hopefully you keep really good records and receipts. Take your card in to the dr office and show them your card and ask why they are charging you COPAYS that are more than BC has contracted for? If they don't or won't give you a good answer get back to insurance company.

Hope you get that refund quick because I really think you should be getting one.

 

I've seen this kind of situation before. Having been working as a Medical Claim Auditor for more than 10 years, this is nothing new to me. If your provider is under contract with BCBS, he must follow their rules, including how much he can charge for the copay. If the provider charges more, he will get trouble. BCBS can fine him or terminate his contract with them. He'll lose many patients. Try not getting too heavily involved between BCBS and provider. Let your insurance company take care of it for you. In some case, the insurance company can give refunds to their customer if copay is over the limit amount per contract. Let me know how's things go. Remember, document everything and get in writing.

 

I hate this for you!!!

I know it is quite a haul, but I love (I mean LOVE) my chiro in Cary.
I can pass along his info if you are interested.

 

sorry

Sorry to hear you've had to come out of pocket more than neccasary.But-congratulations on being a savvy consumer!I'm the worst about checking what someone charges me-and even worse about raising sand if Im due some $$ back.It kills my wife.But you are smart-even though insurance is involved-you still check your bills.Good for you-and good luck!

 

Just think all the money that you would get back and you can put it towards to kids' braces. I hate when Medical people take advantage of us

 

I was thinking the same thing Rostrawberry. I was thinking more along the lines of Christmas as medical bills have been so outrageous this year. Wakemed jokes every time we go in there for one of the kids' surgeries that we should have our own wing by now. Yep, the bills prove that one--LOL.

But yes, the money would be greatly appreciated to recieve it back as it doesn't belong to them apparently. Sad part is, they knew financially, we were rather strapped. So why over charge to begin with? Does this happen w/ many practices? I just can't stand it when people are dishonest and I think that is what is bugging me the most about this whole situation. It's not that it happened, it just that people that seem to genuinely care are ripping me off! I'm hurt and angry at the same time. Hope that made sense.

Thanks for all the advice everyone. It is appreciated. I'm hoping to get there Monday after going to a dr. appt. for my son. Bring on the Cochlear!!! We're ready for him to hear the world. So excited. But after that appt., going to the chiro to see what they are going ot do. I'm not going to be mean about it, just straight forward and see what happens.

Have a great rest of the weekend.

Stephanie--mom to 7

 

I had a similar problem, but not with a chiropractor. What I did was contact my insurance co. and explain the situation. They didn't scream fraud, but did say that some offices "seem to have some problems" in billing the agreed fees. They (the insurance co.) told me I didn't owe the Dr. any more than my copayment since they were in network and they work out whatever fees with the insurance company. . .they told me what to say to the office and I went in person and I took notes along with the insurance reps. contact info. My insurance rep. told me that IF the office was not understanding, to ask them (the office)to call him. The office staff went round and round with each other after I plead my case - FINALLY, after a good 15 minutes of all of them going 'duh' - they fixed my 'balance owed' to $0.00

Call your insurance company again and see if someone else might be willing to do as my insurance rep did - and be calm, have all of your paperwork (invoices etc.) from your doctor. It may not be intentional fraud, but rather a bookkeeper who doesn't know what they're doing.

 

Cochlear....that is very exciting and I wish him the best of luck. I have some knowledge about this and the Baha.

I understand your frustration and you do need to get that money that is rightly yours.

Ro

 

You sure have a lot of problems with doctors. Goodness, you're always being scammed.

 

Wait-- Cochlear is a go?? Monday?? Really??? PM me and fill me in! (need a ride?)

 

i would confront the doctor and depending on his answer i would reply with a subpoena for the amount he has overcharged you

 

No, just seems that way--LOL. With seeing SO many specialists and dealing w/ so many special needs, things are bound to happen. It's just how we learn to deal w/ things as they come that is beneficial.

For those following a post from a couple of weeks ago, my daughter did have her second surgery on her arm. She will have some function of it but we do not know the extent yet. Great news is, she's out of pain and that's what counts!

Got to run. Thanks for all the advice on and off theforum regarding this chiro issue. Like I said, going to ask them kindly for it. If they don't cooperate, we'll go the insurance route to get it back.

Take care,

 

I have a FRAUD attorney if you want his name :twisted:

 

The doctor can only charge you your co-pay for the office visit, but what about expenses that insurance dosen't cover? My doctor charges us $8 every time we have blood drawn, and says insurance dosen't cover the fee. Is that legal? Is this what happening to Stephanie- charges that insurance dosen't cover?

 

Softball mom,

Insurance company said they paid the rest in full. There is nothing that they haven't covered. I know exactly what you mean though by that. Some places we go, insurance doesn't pay it fully and we are responsible for the rest. That is not happening here though. For all our eye exams, the insurance pays $70 for basic exam. Ours are $74. Just $4 more but we are responsible for whatever insurance covers. BCBS told me though that they are paying the rest in full and there is nothing that isn't covered in regards to the chiro care. Good luck w/ the blood draw stuff. Typically though, insurance usually pays fully for a blood draw. Double check w/ your insurance to be sure.

Take care,

Stephanie--mom to 7

 

I used to pay health claims. If a person went in for an office visit and had blood drawn anthen had some tests done, the blood draw was supposed to be included in the offic visit. If they went in specially to have a test done and had no office visit, just a blood draw, we paid for it. Either way, the patient wasn't supposed to pay for it. I paid claims for multiple companies and this was the same with all of them. However, that doesn't mean that you insurance is the same.

 

I'd take him to the cleaners :twisted: :twisted: