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I have been going to a doctor and was told that I didn't have to pay my co-payment from my insurance because medicare would pick up the balance due. Then I started to get calls from a collection agency. Over and over again the calls were comming.
I made payments...Finally I did some research and found out they had not made any claims with my insurance company, BCBS (Blue Cross Blue Shield) since 2006...So, I had been paying out of pocket for the full amount of the bills when I had insurance through collection even though each visit I paid the copayment due.
Finally when I found out that the claims were not made since 2006, they said they'd wipe the balance due clean...I said that's not good enough because I want to know where my money went...Co-payments, and collection and why for so many years they were not sending my bills to the insurance...Is this insurance fraud? Claiming to use insurance to get my business when they weren't?

Submitted: 61 days and 22 hours ago.

Category: Legal

Value: $15

Status: CLOSED

State/Country relating to Question: Florida

Already Tried:
I tried contacting the insurance company...The first time I spoke to someone at Blue Cross she was shocked that a claim had not been made in several years. Then they said they would give me a credit, but not the record of payments by collec or the fact that the doctor hadn't filed claims. I said that was not what I wanted because I wanted a record of what the doctor had been paid by Medicard, them and myself through collections. Neither the University where the Dr. works nor Blue Cross would supply any detailed hard copies to show if they paid the Dr. anything and I was therefore overcharged through collections, the Dr.'s office was negligent or where any of my monies went. Does this sound like fraud?

Posted by JB Umphrey 61 days and 21 hours ago.

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61 days and 21 hours ago.

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Yes...She was the one who said she would wipe my record clean...I told her I didn't want it wiped clean...I wanted a hard copy of my record...for taxes, etc...Again I have not recieved anykind of complience on their part. c

Posted by JB Umphrey 61 days and 21 hours ago.

Info Request

You told her that you wanted a hard copy of what, specifically?

61 days and 20 hours ago.

Reply

A record of my payments...my financial account.When payments were made and how much...At the office and through collections. As well as who else paid their office on behalf of my account ie., Blue Cross, Medicare, when and how much.

Posted by JB Umphrey 61 days and 20 hours ago.

Info Request

Have you discussed your concern with your doctor?

61 days and 20 hours ago.

Reply

Yes...but he told me that he doesn't have anything to do with office finances and I should speak to the office manager...which I did...He said he would take care of it., but the harrassing phone calls still came from the collection agency. It wasn't until several months later when I went to the University financial office (the office manager is different than the University Medical School) when someone saw his records and saw that nothing was ever filed with BCBS in years

Posted by JB Umphrey 61 days and 20 hours ago.

Answer

You can file a complaint with the State Attorney General's office. Their contact information can be found at: http://myfloridalegal.com/pages.nsf/Main/60FD9BD8FA71A5B185256CD1005EE5C5

Be sure to clearly outline for them how your doctor did not bill your insurance provider, you were paying out of pocket, and now your doctor is refusing to provide you with a copy of your account billing activity. Explain how you believe that you were wrongfully charged for services instead of having your matters first submitted for insurance billing.

Good luck and best wishes! I hope that you find this information to be helpful and this answer to be ACCEPTable!

61 days and 20 hours ago.

Reply

Would you suggest I hire an attorney to request the records?

Posted by JB Umphrey 61 days and 20 hours ago.

Answer

You are certainly free to do that. I do not believe that it will help or hurt you, though. If anything, they'll think you're going to sue them for malpractice for some type of treatment they gave you. That's when attorneys contact doctor offices.

61 days and 20 hours ago.

Reply

One other question....It seems obvious, but aren't I due a detailed accounting of my account going back 3 years simply by requesting it? I shouldn't have to go through the courts to get it, should I?

Accepted Answer

Yes you are entitled. No, you should not have to go through the courts. That's why I encourage you to file a complaint with the attorney generals office and have them open an investigation on it.

Accepts:
Expert:	JB Umphrey
Pos. Feedback:	97.7 %
Answered:	9/20/2009

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Michigan lawyer who explains basic criminal, consumer, and contract-related matters.

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Have you discussed your request with the office manager?

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Yes...She was the one who said she would wipe my record clean...I told her I didn't want it wiped clean...I wanted a hard copy of my record...for taxes, etc...Again I have not recieved anykind of complience on their part. c

Info Request

You told her that you wanted a hard copy of what, specifically?

Reply

A record of my payments...my financial account.When payments were made and how much...At the office and through collections. As well as who else paid their office on behalf of my account ie., Blue Cross, Medicare, when and how much.

Info Request

Have you discussed your concern with your doctor?

Reply

Answer

Reply

Would you suggest I hire an attorney to request the records?

Answer

You are certainly free to do that. I do not believe that it will help or hurt you, though. If anything, they'll think you're going to sue them for malpractice for some type of treatment they gave you. That's when attorneys contact doctor offices.

Reply

One other question....It seems obvious, but aren't I due a detailed accounting of my account going back 3 years simply by requesting it? I shouldn't have to go through the courts to get it, should I?

Accepted Answer

Yes you are entitled. No, you should not have to go through the courts. That's why I encourage you to file a complaint with the attorney generals office and have them open an investigation on it.

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Thank you for using JustAnswer! Have you discussed your request with the office manager?

Reply

Yes...She was the one who said she would wipe my record clean...I told her I didn't want it wiped clean...I wanted a hard copy of my record...for taxes, etc...Again I have not recieved anykind of complience on their part. c

Info Request

You told her that you wanted a hard copy of what, specifically?

Reply

A record of my payments...my financial account.When payments were made and how much...At the office and through collections. As well as who else paid their office on behalf of my account ie., Blue Cross, Medicare, when and how much.

Info Request

Have you discussed your concern with your doctor?

Reply

Answer

Reply

Would you suggest I hire an attorney to request the records?

Answer

You are certainly free to do that. I do not believe that it will help or hurt you, though. If anything, they'll think you're going to sue them for malpractice for some type of treatment they gave you. That's when attorneys contact doctor offices.

Reply

One other question....It seems obvious, but aren't I due a detailed accounting of my account going back 3 years simply by requesting it? I shouldn't have to go through the courts to get it, should I?

Accepted Answer

Yes you are entitled. No, you should not have to go through the courts. That's why I encourage you to file a complaint with the attorney generals office and have them open an investigation on it.

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