<p>I’m hoping you all might be able to help me with a recent situation I encountered, as I’m not very familiar with medical insurance (despite trying to read as much as I can about it).</p>
<p>I recently saw an in-network nurse practitioner. She took my credit card as payment, and I later found out she charged me the entire cost of the appointment ($300!) up front. I have called my health insurance company, and found their contract online, in which they state “a provider agrees to submit a claim to the insurance company and to collect no money at the time of service.” (It later lists the office co-payment as an exception). It also states that it is okay to bill for the entire cost if the patient does not provide proof of insurance, but when proof of insurance is presented, the provider must refund the cost difference.</p>
<p>I am unsure how to proceed now. I provided my insurance card at the time of the appointment, and assumed that my credit card would be used for the co-pay ($30). $300 is a lot of money to me, as a 21 year old, and I recently switched jobs, so am trying to be very conscious of my spending. I don’t really think my insurance is going to reimburse $300/hr for a nurse practitioner, and imagine I’ll be on the hook for covering the difference. </p>
<p>Do I have valid grounds to dispute the charge on my credit card? I am fully willing to pay the co-pay, but she is saying that I need to pay the full cost since I didn’t fill out her “Insurance Verification Form” prior. I assumed that my health insurance card would be proof of insurance, as it has been in every other healthcare situation I have been in.</p>
<p>I’d really appreciate any advice you all may have. Thanks in advance.</p>
<p>I would contact the provider first to try to get them refund the money to you. If you are not successful, then ask the credit card to refund the money back to you. You should never give your credit card to anyone unless they have presented you with a bill. They can´t charge you without your agreement, whether it is your obligation to pay or not.</p>
<p>If she is part of your health insurance network, she needs to abide by your insurance´s rule on payment. By providing her with your insurance card, you have already done your part. It was up to her to do verification. If she had determined you were not qualified, or she did not accept your insurance, then she should have informed you (and it really should be before she provided any service).</p>
<p>Recently, due to snow, we had to change our flights. Because it was due to weather, the change was suppose to be free, but the airline charged us without our knowledge (they used our credit card on file). We reported it to the credit card company, and we were credited pending investigation.</p>
<p>First, check and make sure that you do not have an in-network deductible to pay before the copayment starts. If you can, print off a copy of the Explanation of Benefits for this visit (the page that shows the date, the charge, the allowable amount, and the amount you should pay) from your insurance company’s website and bring it to or fax it to the nurse’s office with a request that your credit card be promptly credited back the $270 that was overcharged, and that they call you to let you know that it is done.</p>
<p>Your providing her with your insurance card should have been enough. She’s obligated to follow the contract she has with your insurance company. </p>
<p>And I hope you really used a credit card – and not a debit card that says Visa or something similar – because refunds can be very slow to make it back to debit cards, and your consumer protection is not as strong.
I hope this is easily fixed; if not, a credit card chargeback and a complaint to your insurance company would both be in order.</p>
<p>You should not be on the hook for any difference. It is a violation of that provider’s contract with the insurance company to charge anything beyond the pre-negotiated rates. Did she actually bill your insurance or did she tell you to send the paperwork to the insurance company? I would also call the credit card and ask their advice if you can open a dispute of the charge (did she give you a receipt as soon as she took your cc information?); most likely, the cc will tell you to try to work it out with the clinic first. Remember, you have 60 days to start a charge dispute with cc.</p>
<p>If you don’t get satisfaction from the provider, then you are well within your rights to call the Member Services number on the back of your insurance card and tell them the whole story. Assuming she is an in-network provider, she is required to abide by their contract or be kicked out of the network.</p>
<p>I work for an insurance company. She needs to give you back that money… she’s obligated to charge you just your co-pay by being in network and receiving your card (unless you have some sort of deductible to meet first but it doesn’t sound that way).</p>
<p>I would suggest calling your insurances customer service # on your card (sometimes listed as member services) and ask if they can help you get it back. Ask to speak to somebody in their claims department. We always have providers inexplicably bill their patient up front and then file to us and get paid from us also. We send letters to providers telling them they must refund the patient when things like that happen.</p>
<p>Could it be she just hit the zero one time too many for your co-pay?
Especially if the NP was the one processing the payment, rather than the receptionist/office manager.
I would call to clarify.</p>
<p>According to what the OP has supplied, “the provider must refund” the difference when the proof of insurance is presented [after the service]. She can not keep the full amount. She is violating her agreement with the insurance company. In my experience, member’s services loves to get all over providers to comply with their contract, and will do so. If she does not cooperate, write to your insurance company, and include a copy of your receipt. If this does not work, you can write to the insurance department in your state and complain about both the insurance company and the practitioner. I would let her know that you will do this if she continues to violate the contract. No normal practitioner would want such a complaint.</p>
<p>Caveat here - that the contract and facts are as you have stated - or this advice will not be appropriate.</p>
<p>Wow, thank you very much for all of the great (and quick!) advice here. I really appreciate the response.</p>
<p>I received a response back from the provider this afternoon. I continue to be unimpressed by her lack of professionalism and definitely will not be going back to see her again. She continues to insist that the insurance card is not valid proof of insurance, and I owe the full amount because she can’t afford to hire a receptionist to check benefits, as “specialists further up the food chain” do (her words, not mine). She then went on to randomly state a 1999 Gallup poll about nursing being the most ethical profession(?). She said she thought I was clear about the terms of the “deposit” required.</p>
<p>Luckily, I did log-on here briefly, just before 5pm to see many of the helpful responses and rushed to call my health insurance company before they closed. They confirmed I have no deductible and it’s covered at 100%, so I should only owe the co-pay. They didn’t seem very eager to take any other action, but I asked if there was anything on their end that they could do to enforce the policy, as she is a provider within their network, and even suggested they send a letter (thanks for letting me know about that, fendergirl!). She put me through to the voicemail for the provider relations department and I expect I won’t hear back from them, until Monday, since it was after business hours when I called.</p>
<p>Thanks again for all of the excellent advice here. I’ve certainly learned my lesson about providing my credit card without first seeing the bill!</p>
<p>A card by itself is technically <em>not</em> considered proof of insurance. For example, it could very well be an old card from a policy that someone no longer has in force. (We get this a lot…) However, once you show that card, it’s up to the provider to either call the insurance company to verify the coverage and/or benefits or file a claim and wait for a response. She can’t make you pay 10x as much because she’s too lazy to check on it. If she doesn’t have time to make a 2 minute phone call (literally), then she needs to find a new profession.</p>
<p>I wish you luck getting back your money. If she files the claim to the insurance and gets paid twice then in theory she will need to pay somebody back… otherwise her accounting books won’t line up and that’s fraud. If she’s calling it a “deposit”, will she refund your money once the insurance company pays their part?</p>
<p>arabrab is right-- you need to address your in network deductible. That said, its not likely that the full cost of the service is approved by the insurance company, so she should only have charged you the in-network discounted rate. But if, say the insu co allows $200 for the $300 service and pays all but a $30 copay, the NP can charge you the $200 (the $170 they would have gotten from the insu co and the $30 copay).Its not likely your deductible had been met the first week of the year.</p>
<p>*** Oops just saw that you dont have a deductible for this service. Call your credit card co and put the charge in dispute. Then write a letter to provider relations of your insu co. Insu cos take their contracts with provider spretty serioulsy. She’ll be hearing from them.</p>
<p>If your insurance company doesn’t seem interested in acting on your behalf, contact your state insurance commissioner. I’ve been told that insurance companies hate inquiries from the state, which may light a fire under them to go after the provider. And definitely contact your credit card company to dispute.</p>