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My wife gets regular treatment at The Pain Center In Philadelphia,

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PA. approximately 3-4 times...
My wife gets regular treatment at The Pain Center In Philadelphia, PA. approximately 3-4 times a month for chronic debilitating muscle pain. There has been an issue between The Pain Center & Excellus Blue Cross Blue Shield regarding the procedure codes submitted for reimbursemnet. On several ocassions i.e., Excellus Blue Cross Blue Shield has sent reimbursement checks to me (I am the principle insured through my job) which I signed over to the Pain Center. On June 11, 2010 I recieved a bill from ExBCBS for on of the previously mentioned checks. On a seperate Status of Claims Submitted form, ExBCBS states that this claim ($4,800) was "inadvertently paid withour review." This Status of Claims Submitted form lists several other claims "Inadvertently Paid" totalling $4512. which I believe we will be asked to pay. My wife relied on the belief that these claims would be paid, or she would not have consented to treatment.

Do we have to repay these amounts?

Jim Sutton
Submitted: 8 years ago.Category: Legal
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Answered in 9 minutes by:
6/12/2010
Lawyer: Phillips Esq., Attorney-at-Law replied 8 years ago
Phillips Esq.
Phillips Esq., Attorney-at-Law
Category: Legal
Satisfied Customers: 22,750
Experience: B.A.; M.B.A.; J.D.
Verified

Thank you for giving me the opportunity to assist you. I encourage you to ask me for clarification, if you are not clear with my Answer.

 

My wife gets regular treatment at The Pain Center In Philadelphia, PA. approximately 3-4 times a month for chronic debilitating muscle pain. There has been an issue between The Pain Center & Excellus Blue Cross Blue Shield regarding the procedure codes submitted for reimbursemnet. On several ocassions i.e., Excellus Blue Cross Blue Shield has sent reimbursement checks to me (I am the principle insured through my job) which I signed over to the Pain Center. On June 11, 2010 I recieved a bill from ExBCBS for on of the previously mentioned checks. On a seperate Status of Claims Submitted form, ExBCBS states that this claim ($4,800) was "inadvertently paid withour review." This Status of Claims Submitted form lists several other claims "Inadvertently Paid" totalling $4512. which I believe we will be asked to pay. My wife relied on the belief that these claims would be paid, or she would not have consented to treatment. Do we have to repay these amounts?

 

Response: No, you do not for the reasons that you have already stated. Your wife relied on the information that she received from the Pain Center and her insurance company to incur the bills. The insurance company may send her accounts to collections or refuse to cover future services until the bill is resolved. It would be necessary for you to contact the insurance company's customer relations to voice your concerns to ensure that your future medical services are not going to be compromised because of this bill.

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Customer reply replied 8 years ago
In addition to ExBCBS customer relations, is there any other impartial group; insurance review board or so forth who can help? On the Staus of Claims report there are several other instances of checks issued; signed over to The Pain Center and payment stopped which are reported as "inadvertently paid." That seems suspicious - the same thing happening repeatedly. Is there someone with oversight of their billing practices? Would it be helpful to contact them? Finally, is there a step to take to proctect my excellent credit rating through all of this? Thanks.
Lawyer: Phillips Esq., Attorney-at-Law replied 8 years ago

 

In addition to ExBCBS customer relations, is there any other impartial group; insurance review board or so forth who can help?

 

Response 1: Yes, you can file complaint with Pennsylvania Department of Insurance. Click here to file your complaint:

 

http://www.portal.state.pa.us/portal/server.pt/community/file_a_complaint/9258

 

 

On the Staus of Claims report there are several other instances of checks issued; signed over to The Pain Center and payment stopped which are reported as "inadvertently paid." That seems suspicious - the same thing happening repeatedly. Is there someone with oversight of their billing practices? Would it be helpful to contact them?

 

Response 2: See my Response #1 above.

 

Finally, is there a step to take to proctect my excellent credit rating through all of this?

 

Response 3: Nothing at this point since your account has not been reported to the credit reporting bureaus and the dispute is in its early stages. First thing is to get the matter resolved and if your account is reported to the credit reporting bureaus for being delinquent, you can then dispute the report by using information from your dispute resolution.

 

 

 

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Customer reply replied 8 years ago
When you say the insurance company may turn the account over to collection or "refuse to cover future services until the bill is resolved"- do you mean services at The Pain Center or any and all services? (I have a transplanted kidney and my medications alone cost over $1000 per month). Thanks.
Lawyer: Phillips Esq., Attorney-at-Law replied 8 years ago

When you say the insurance company may turn the account over to collection or "refuse to cover future services until the bill is resolved"- do you mean services at The Pain Center or any and all services? (I have a transplanted kidney and my medications alone cost over $1000 per month).

 

Response: Any and all services.

 

This is my final response to your original post.

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