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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by wishingstar on January 9, 2007, at 10:57:54
I think I'm going to be sick! You wont believe this.
Just in a whim I decided to check my health insurance website where I can look at all my claims and their status. I have a lot of trouble with them so I like to check regularly to make sure things are progressing as they should with some medical bills I have from a hospitalization last year.
I clicked the first one, it said $112 had been paid on Dec 14, 2006... TO ANNE!! Anne and I had submitted claims way back.. maybe last January (2006) or so? And they were denied because of the pre-existing condition clause. So we worked something out and I payed her out of pocket at a reduced fee ($45 an hour rather than $70). And that was that. I never resubmitted anything and neither did she, as far as I know. I didnt owe her one penny when I finished with her.
So what is this all about? I dont get it. I guess over time and more processing they decided to cover it after all. With my insurance company, that doesnt surprise me at all - theyre crazy. I called them just now and they assured me that the $112 was the only time she had been reimbursed. They said it was for two claims - one on August 28 and another on Sept 6. I looked in my old calendar book and I did see her on both of these days. So she must have submitted to insurance again. Otherwise, how would they have known? The last day I saw her, just before being dropped, was actually that second date. Sept 6. I went into partial a few days later. Now, my insurance did roll-over into the second year of coverage on Aug 25, and we may have discussed hoping that it'd now cover therapy with her, since sometimes preexisting issue disappear then. We probably mentioned it, but I dont remmeber for sure. But still, shouldnt she have told me she was submitting the claim? And either way, now shes being overpaid, because I paid her my regular $45 for both of those appointments, and now shes getting reimbursed beyond the $70 even.
Now, I'm only 24 and not too skilled with insurance matters - if this makes sense to someone else, please tell me. I could be misunderstanding. But to me, it sounds like she resubmitted after I finished seeing her and never told me about it, and isnt planning to.
My second, and even bigger concern, is dealing with her now. No way in hell is she going to get $112 for free, even if I was paying her reduced rate and in one way do "owe" it because of that. It was the deal from the beginning. Given what we agreed upon, I dont owe anything, and given how she treated me, I'm not going to let it go. If it were Laurie, I'd let it go. But not Anne. I think I need to call her, but that is a fate worse than death for me. I dont want to talk to this woman for any reason at all. I know it'll bring up a lot of really strong, really hard emotions that I've been working so hard to let go. But it's also about principle to an extent, and about the fact that I only have a few hundred dollars in the bank now and could use that extra money she has, to a greater extent.
What do you all think? I'm actually feeling sick to my stomach just thinking about this. I dont know what to do.
Posted by Poet on January 9, 2007, at 11:21:59
In reply to You've got to be kidding..... Anne, posted by wishingstar on January 9, 2007, at 10:57:54
Hi Wishingstar,Do you have cancelled checks or receipts showing you paid for those sessions? If you do I think you should send copies to the insurance company and let them deal with it. It could be that what you paid ended up being what your co-pay would have been had she billed insurance, and the $112 is what they would have paid her.
My insurance company keeps putting Dr. Clueless out of network and my T in network. I don't want to say anything because my T is getting paid more per session, and I see Dr. Clueless every two or three months and so paying more co-pay isn't real bad. Though T says the insurance company will catch it, and she'll end up paying back the over payment. I hope not.
If I were you I'd let the insurance company deal with Anne, they're the experts. Insurance just confuses the rest of us, I know it does me.
Poet
Posted by mair on January 9, 2007, at 12:22:38
In reply to You've got to be kidding..... Anne, posted by wishingstar on January 9, 2007, at 10:57:54
This stuff is confusing.
Unless, I'm misunderstanding what you're saying the reduced fee arrangement was based upon the fact that your insurer wouldn't cover your sessions. Under the best circumstances for her, she was entitled to receive no more than $70 per session and in fact she received $101 (your $45 plus $56, or one-half of the amount she got from the insurer.) Under the worst of circumstances, she was entitled to receive only what the insurer's "approved amount" was, possibly less than $70.
Since the lower rate was predicated on a lack of coverage, I think she has the right to charge $70 for the 2 sessions that were covered. Thus she would owe you at least $31 for each of the sessions covered by the insurer ($101 received less $70). I don't believe she can, under any circumstances, take the full amount of the check she got from the insurer and apply it against all of the other reduced fee sessions.
I really hate dealing with the insurance company and waiting for them to do anything. You can start there, but I might be inclined to write her a letter requesting that she remit the overpayment to you.
My own T is wonderful in many respects, but her understanding of insurer financial arrangements is, or at least used to be, rather limited. I discovered early on that she was overcharging me, not maliciously, but more because she really didn't understand the deal she had struck with my insurer. She simply did not understand that she wasn't entitled to bill me the full difference between her normal and customary hourly rate, and what the insurer paid her as a network provider. She was really only entitled to the difference between what the company paid her and the company's approved rate.
So maybe Anne thinks that what she's doing is ok.
mair
Posted by TherapyGirl on January 9, 2007, at 17:27:10
In reply to You've got to be kidding..... Anne, posted by wishingstar on January 9, 2007, at 10:57:54
I agree with Mair. I think you should write her a letter requesting a refund of the overpayment. You may want to call your insurance company first (or look at the Explanation of Benefits online) and see what they have listed as her contracted rate and as your co-payment, then go from there.
Posted by wishingstar on January 9, 2007, at 17:51:56
In reply to Re: You've got to be kidding..... Anne » wishingstar, posted by TherapyGirl on January 9, 2007, at 17:27:10
Thanks for your thoughts everyone. I'm a little more than confused with all this insurance stuff.
For some reason, the idea of writing her a letter didnt even occur to me at first. But I think that is what I will do. I have typed up a fairly professional-sounding letter mentioning the situation and the amount of overpayment and asked her to contact me either by phone or by mail to clear it up. I did some math and at the very least, she has been overpaid by $64. That may not seem like much to some, but it is to me. I think I may also leave a message saying I have sent her a letter regarding a financial issue to be sure she reads it and doesnt trash it, assuming it's just some angry letter about how I feel.
I think I will wait until I see Ginny on Thurs to send it. That will make me feel a little better about it. I've calmed down a lot since originally posting this morning - the initial idea of having to deal with this woman against just sent me into a bit of a tailspin for awhile. But I'm okay now. Thanks everyone for your help.
Posted by Fallen4MyT on January 9, 2007, at 18:22:06
In reply to Re: You've got to be kidding..... Anne, posted by wishingstar on January 9, 2007, at 17:51:56
My insurance company will back a check out all I have to do is call. Maybe yours will do the same. You do not to my knowledge have to prove you paid her
Posted by wishingstar on January 9, 2007, at 19:30:59
In reply to Re: You've got to be kidding..... Anne » wishingstar, posted by Fallen4MyT on January 9, 2007, at 18:22:06
What do you mean? I dont think I understand.
Apparently the check was already sent back on Dec 14, so I imagine she's already deposited it. Or has it in her hands if nothing else.
Posted by muffled on January 10, 2007, at 1:16:57
In reply to You've got to be kidding..... Anne, posted by wishingstar on January 9, 2007, at 10:57:54
Sorry WS, this is hard.
I think I would just walk away.
Just walk away.
But I am not in your position.
So I dunno :(
Take care,
Muffled
Posted by Fallen4MyT on January 10, 2007, at 2:10:40
In reply to Re: You've got to be kidding..... Anne » Fallen4MyT, posted by wishingstar on January 9, 2007, at 19:30:59
Sorry to be confusing WS...I tend to type in shorthand and have a lot of experience with insurance so I tend to think others can read my whole thought when I type. OK doctors and T's take many different insurance and they have a lot of clients. I understand she got the check and may have cashed it but it doesn't matter because she has contracted to work with this insurance company. So NEXT time someone uses the same company(we will use the name Milly) ..lets say Blue Cross they will send paperwork showing it was covered for Milly but they will credit BACK what they paid on *you* back to themselves. So say they paid $200.00 on Milly's claims they will show that then say on a form the docs/T's office gets showing a negative -$65.00 (whatever they paid her for you) and then they type in the claim number you had and reason they are backing it out..say overpayment in this case....So her next check will only be $135.00 with the explaination
YOU pay for your insurance so they work for YOU. As you paid her the agreed on fee...she was paid twice and thus you have a right to have them back that check out as some of them call it. Its done all the time. .Its all more or less behind the scenes stuff. I hope this is clear now.> What do you mean? I dont think I understand.
>
> Apparently the check was already sent back on Dec 14, so I imagine she's already deposited it. Or has it in her hands if nothing else.
Posted by wishingstar on January 10, 2007, at 13:57:13
In reply to Re: You've got to be kidding..... Anne » wishingstar, posted by Fallen4MyT on January 10, 2007, at 2:10:40
Thank you fallen, that did clear it up some. I may ask to have that done. I'm going to mention the problem to Ginny tomorrow and go from there.
I just got a bill in the mail, I assume for the psych hospitalization last Oct, for $4200. I dont even have a third of that in the bank, period. Hahahaa. At least these bills keep their clients coming back.
Posted by wishingstar on January 10, 2007, at 15:47:02
In reply to Re: You've got to be kidding..... Anne, posted by wishingstar on January 10, 2007, at 13:57:13
I sent a letter to Anne this afternoon. It was very formal - I couldnt have been more emotionless if I tried. I just stated what the situation was and asked her to contact me either by phone or mail, whichever she preferred. I also left a voicemail saying that I had mailed something regarding payment so that she would be sure to see it and read it, not assume it was some angry mail (again) and throw it away. It was weird to hear her voice on the message.
I know I probably should have done this through the insurance company as you all suggested. I dont really know why I didnt. I just felt like I wanted to deal with it directly. I'm definitely not hoping for any sort of apology or caring from her - that isnt it. I just dont know. I'll be out of town until Monday so we'll see what happens when I get back.
This is the end of the thread.
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