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Jack R.
Jack R., Attorney
Category: Legal
Satisfied Customers: 6147
Experience:  OH/TX Practicing Attorney focusing on Family Law, Foreclosure, Landlord-Tenant Issues.
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If a doctor is a preferred provider of your insurance company,

Resolved Question:

If a doctor is a preferred provider of your insurance company, does he HAVE to submit claims for the provided services ?   What if he says the insurance doesn't cover the procedure, and yet there is a billing code for the service provided ? Can they charge you more than your co-pay for services, also ?
Submitted: 7 years ago.
Category: Legal
Expert:  Jack R. replied 7 years ago.

Doctors complete paperwork for insurance companies as a service to the clients. They do not have to submit the paperwork unless there is a contractual obligation between you and the doctor for him to do so.. Nothing prevents you from submitting the paperwork to the insurance provider as well. You can ask the doctor to complete the work including the proper coding.

 

 

This communication is not intended as legal advice. A local attorney should always be consulted for legal advice. No client/attorney relationship is intended or created by this communication.

 

Customer: replied 7 years ago.
The insurance company will not reimburse ME, as much as he would the doctor. I would only have to pay the $ 15 co-=pay. Instead the doctor charged us CASH $ 7100, for the services, because he said the insurance company had no billing code. They do have a billing code, and they are a registered preferred provider with BX-BS...
Expert:  Jack R. replied 7 years ago.

You should ask the insurance company directly for a letter indicating what the coverage is for the medical procedure you obtained from the doctor. You can then take that letter to the doctor so he cannot deny the procedure is covered. This will at least prove that the doctor is wrong.

 

 

This communication is not intended as legal advice. A local attorney should always be consulted for legal advice. No client/attorney relationship is intended or created by this communication.

 

 

 

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