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#335087 - 07/02/10 10:28 AM Question about how much the Dr bills and Ins. Pays
kidneythis Offline


Registered: 11/08/09
Posts: 1558
I had an accident and my PIP is paying but they aren't paying the full amount the doc is billing. In some cases its hundreds below.
The insurance company pays "usual and customary" charges which seems to mean whatever they want it to since they pay almost all of individually billed chiro and clinic visits (to within 10 bucks) and cut nearly in half bills of several visits submitted at one time. They have halved the Xray bill and cut a third off the Physicians portion of the Emergency room bill, two times.
What can I do to make sure I am released financially by these doctors, hospitals and Imaging companies w/o having to pay them the extra before I let the insurance company go?
My idea was to try to get the insurance company to get that release for me and refuse to release them until they did. Any help here would be great.
Especailly if you know the industry.
I'm not anywhere near close to healed but I'd like to be on top of this as the numbers are already over a thousand that hasn't been paid and it looks like it'll take a while before I heal fully.

Thanks in advance Men

KT



Edited by kidneythis (07/02/10 10:29 AM)
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#335096 - 07/02/10 11:45 AM Re: Question about how much the Dr bills and Ins. Pays [Re: kidneythis]
kidneythis Offline


Registered: 11/08/09
Posts: 1558
Whoofff

OK I just had a horrible experience with a real lowlife at my insuarnce company. I would ask "is this total amount billed on this day inclusive of the amount that was billed for X day which has been paid" The difference in payment was exactly the same amount. reply " we paid $X. then quotes state law"
I asked again if she could "please say yes or no to my question" to which she replies " yes, Whatever ...." and I stopped her and told her that she "can't have it both ways its either; Yes. or whatever... not both." Then she asked me why I was upset. When I answered she interupted and started to talk about something that hadn't been brought up and we went on and on with her deliberately not answering the question I asked in various ways mostly by answering a question I did not ask, then asking me why I was so upset then interupting me when I replied. I finally asked for her supervisor and got put on hold limbo.
I called back and within 45 seconds the next person answered my question and resolved the matter in an almost anticipatory way. I half believe she was sitting next to the person I was argueing with. I was then able to ask the next question which is the one on top of this post.
I'm waiting for a written proof of this that I can look up and verify. But as it stands I was told that State law says the doctors and any providers of health care for an auto accident have to accept the amount paid according the the State fee Schedule and not try to collect the amount over. She said this was a write off for them.
Thank You all



Edited by kidneythis (07/02/10 11:46 AM)
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As Mark Twain once quipped, history may not repeat itself, but it does rhyme.

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#335244 - 07/04/10 04:17 PM Re: Question about how much the Dr bills and Ins. Pays [Re: kidneythis]
kidneythis Offline


Registered: 11/08/09
Posts: 1558
I got the letter and it does say I am not responsible for the difference in the payout, which is according to State Work Comp scale, of the amount over the payout that the medical provider is charging.
I didn't see any law or regulation named to support this statement.
I am worried because I saw a guy in small claims get dinged for hunmdreds in bills from an auto accident when the insurance decided to stop paying.



Edited by kidneythis (07/04/10 05:17 PM)
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As Mark Twain once quipped, history may not repeat itself, but it does rhyme.

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#335302 - 07/04/10 10:55 PM Re: Question about how much the Dr bills and Ins. Pays [Re: kidneythis]
onlyakid Offline
Member
MaleSurvivor

Registered: 03/31/04
Posts: 1552
Loc: New Jersey
I would forward these bills to your health insurance carrier as alot of them will pay for accident injuries (especially after the car insurance pays). It can't hurt to try. Also was the accident your fault? If not then you should also contact the other drivers insurance company.

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#335344 - 07/05/10 02:49 PM Re: Question about how much the Dr bills and Ins. Pays [Re: onlyakid]
kidneythis Offline


Registered: 11/08/09
Posts: 1558
Thanks Onlyakid,
In my state your own insurance pays by law its a form of no fault. The other guys company took responmsibility and will be paying the final settlement when I am fully healed or ready to let them off the hook whichever seems best when the time comes.

The letter I got from my Insurance company the other day says that by law the amount of the bill over the payment issued by the insurance carrier is a write off for the doctor. They cannnot legally collect it.

I still have to confirm this by finding it in the law itself on the State website but I don't doubt it much anymore.

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As Mark Twain once quipped, history may not repeat itself, but it does rhyme.

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