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Provider possibly not submitting something to insurance - how to handle?

543 Views | 2 Replies | Last: 23 days ago by 94chem
dfwag58
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Bit of an odd situation and I'm not sure how to handle it -- had a friend that needed to go to Detox. It was a "things need to move quickly" type situation, so I located a place, talked to them and got him checked in that night. The process was essentially that I paid up-front via credit card, they would try and file it on his insurance, and whatever amount his insurance wouldn't cover they would keep and if his insurance covered it all I would get refunded that amount. I assume that's probably pretty standard for these type places where there's a high risk of someone just never paying.

Now, went into this fully expecting not to recoup any money, but at the same time I at least want to make sure that if something is able to be covered by insurance that it is.

Unfortunately I'm flying in the dark here a bit -- I don't have access to his insurance (or any claim denials or the like he may have received -- he says he has not received anything), and I don't really want to push him on it since he's obviously dealing with a lot of his own issues.

The detox place is very slow to respond to any kind of contact (takes me 3-4 emails to get a response). All they've been able to send me in this time is a copy of the invoice that shows a $6000 payment for detox services and a $250 "deductible/copay/oop". I was charged $6437.50 up front.

What is my best route to take? From what I can tell the detox place has no real incentive to claim it on the insurance (or if they do, to let me know that the insurance covered some) as they already have my money... so I have no real idea if they even bothered to do it.

Can I take the invoice and file a claim with his insurance myself?
befitter
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HPPA laws won't permit them to give you information about any of this. You will have to ask him if the facility filed his insurance and what the result of that was I would think. Do you have a contract with this facility showing this was the agreement?
94chem
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Ask your friend for his insurance login, or let it drop. Either he respects what you did for him or he doesn't.
94chem,
That, sir, was the greatest post in the history of TexAgs. I salute you. -- Dough
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