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John
John, Attorney
Category: Legal
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My sons doctors office over billed our insurance company

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My son's doctor's office over billed our insurance company and refunded the insurance company $387.60. The doctor's office said my insurance "asked for the refund". When I called my insurance company I was told it was in their computer system that the doctor's office over billed and voluntarily sent back a refund. The doctor's office in turn (after months of a paid in full balance) billed me for the same amount that they had refunded to my insurance company. The doctor's office lied and said my insurance company asked for the refund. In made numerous phone calls, teleconferenced with my insurance company with the doctor's office to straighten this out. I last spoke to the office manager and she said this shouldn't involve me it was a billing error and that I would have a zero balance. I received a bill from a collection agency for the same amount refunded to my insurance company!! They have lied and now it has affected my very good credit score!! What actions can I take?
Hi, thanks for submitting your question today. First, when a medical provider agrees to accept a particular insurance, they agree to the particular insurance company's rate of pay for the service...in other words they cannot charge you more for that service.

Now as to the negative credit reporting, there are two general ways to go about getting recourse for this. One is to file an administrative complaint with the Federal Trade Commission. Here https://www.ftccomplaintassistant.gov/FTC_Wizard.aspx?Lang=en

The other option is to file a lawsuit in federal court under the Fair Credit Reporting Act. You will need to show that you demanded the incorrect information be removed and the agency failed to remove it within 30 days. You will also need to be able to prove specific damages in relation to not qualifying for credit, e.g., higher interest, not qualifying for a loan.

I believe this answers your question. However, if you need clarification or have follow-up questions regarding this matter, I will be happy to continue our conversation – select the Reply to Expert or Continue Conversation button. If you are otherwise satisfied with my response, please leave a positive rating as it is the only way I am able to get credit for my answers. Thank you, XXXXX XXXXX wish you all the best with this matter.

 

Customer: replied 3 years ago.

How do I go about filing a insurance fraud complaint/illegal billing against the doctor's office and get a refund?

Hi, thanks for your reply. To file an insurance fraud complaint, contact the Arizona Dept of Insurance explaining the details of the situation. You can learn how and where to file your complaint by following the direction on their website here.
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