I was invoiced for a medical treatment plan that I was not aware of until I received a bill from the Dr's office.?

The invoice said treatment of ankle fracture. My health insurance said it was for a surgical procedure, but I had no surgery, does the nurse cutting off a soft cast count as surgery? when I called the Dr's office they said I was under a treatment plan that I knew nothing about. She said I signed a form for it, but I didn't, and she couldn't produce a copy for me.  My Insurance Co paid their agreed amount for the coding they were invoiced for. Second visit I paid my usual Specialists Co-pay.  Now the Dr's office said that was for the ankle brace.  How did they know that I was going to get an ankle brace on my second visit and why did my receipt say Co-pay?  I'm very frustrated.  How can they charge for a treatment plan without giving you the option to take advantage of.  I could have gone back for the continued problems stemming from the fracture but I got the invoice on the last day of that 90 day treatment plan.   What can I do?  They want to send me to collections because I can't commit to a payment plan for the balance of what the Ins. didn't pay.

6 Answers

  • Edna
    Lv 7
    1 week ago

    Why do you care WHAT they call it, as long as your insurance company accepts the claim and pays for the treatment.

    In medical billing and insurance, "surgery" doesn't always mean that the doctor took a knife and cut you open. Treatment for a fractured ankle is often referred to as "surgery" - by the insurance company or by the doctor. "Surgery" can mean any kind of medical treatment.

    If you have an endoscopy, it's referred to as surgery. If you have a colonoscopy, it's referred to as surgery; but in neither case did a doctor do any cutting on you.

    You were under a 90-day "Treatment Plan". So, what? A Treatment Plan is just that - a written plan of action for the initial treatment of your fractured ankle and follow-ups, until it's healed. A Treatment Plan will be extended for as long as is necessary and for as many months as are necessary. A Treatment Plan has nothing to do with the actual billing - it's just a rough treatment guideline that the doctors will follow.

    How did they know that you were going to get an ankle brace on your second visit? Because a fractured ankle ALWAYS requires an ankle brace - that's how they knew. .

    A Co-Pay is the amount that you have to pay out of pocket for a visit with a doctor - regardless of what the doctor does or doesn't do on that visit. It's what insurance doesn't pay. (Example: A doctor charges $150 for an office visit - that's his basic charge for you just walking in the door. You have to pay the first $20, and the doctor's office bills insurance for the remaining $130).

    They want to send your account to Collections because you haven't paid the doctors the full amount of all your accumulated co-pays for all your office visits. 

  • 1 month ago

    The specialist co-pay is for the doctor's office visit and applied to your deductible. In network providers usually have a 20% co-insurance that is also your responsibility up to the amount of the out of pocket maximum. Your insurance company has to spell this out very carefully to you.

  • Marc
    Lv 7
    1 month ago

    Most people do not know what their insurance does and does not do.  Most people do not understand coding and billing.  You need to call your insurance company and ask them questions.  They will in turn call the doctors office and determine if billing was appropriate.  If you were treated with in a normal scope of practice and billing was done properly then you owe the money.  If you have to pay $10 dollars a month then do it.  You received treatment and the doctor deserves to be paid (if all was done properly. If someone screwed up it will be discovered and corrected

  • 1 month ago

    You're simply being billed for the portion your HC insurance does not cover. When you gave them your insurance card & billing info, THAT is when you signed the form accepting financial responsibility. Idk what they're calling a "treatment plan," but it doesn't affect your liability for the services or balance the insurer does not pay for.

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  • Kieth
    Lv 7
    1 month ago

    Get a lawyer, they are charging you for a procedure that you didn't have, it's fraud. They can't produce the consent form, and that shows that it never took place. All consent forms are electronically scanned, if they can't find it, it's not there. Go to their billing office in person and argue that with them, but if they refuse, get a lawyer.

  • kelvin
    Lv 7
    1 month ago

    you need to contact your health insurance provider and ask them to provide this form to you as your doctor would of sent it to them and they would have to send it to you

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