AboutLisa Lindell Expertise Consequences to the patient and family, reply by healthcare facilities, statistics and types of medical errors.
Experience Extensive personal experience during my husband's 108 day hospitalization.
Publications 108 Days
Education/Credentials Author of the book "108 Days." Speaker at patient safety events across the country, student of medical errors. I've been a patient safety advocate for years.
I went in for some oral surgery and the cost was more than $2000. The surgeon required payment in full immediately and said i would be reimbursed after they were paid by my insurance. I charged it on a credit card because I felt I had no choice but to pay otherwise i couldnt get the services i needed. it's been 6 months and I still haven't recieved reimbursement. I've tried to contact both my insurance and the provider, but each says they're waiting on the other. In all my previous experiences, I never had to make any payments for health care until my insurance had worked it out with the provider determined my liability. My question is are there any laws that protect patients from this sort of thing. I worry that by being forced to pay the provider directly, the provider no longer has any incentive to make sure I get my reimbursement. Thanks in advance for any advice.
Answer A service provider is not required to file an insurance claim on your behalf, nor are they required to accept insurance payment for services rendered (except where they've entered into a contract with the insurance provider on behalf of the insurance company's customers).
If you paid out of your pocket, YOU should have filed a claim with your insurance provider for reimbursement directly to you. When you paid the surgeon, your financial business with him was complete and he's not a party to your insurance reimbursement, therefore has no business filing a claim for himself or on your behalf.
Contact your insurance provider and find out what you need to submit in order to get reimbursed. The oral surgeon is not involved in this transaction. You may need additional documentation from their office, but you get that yourself and submit whatever you need with your claim. I urge you to act quickly, it's not the surgeon's responsibility to get you reimbursed. You are correct, they have no incentive to get you reimbursed, nor do they have any obligation to.
