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Do I have the legal right to a corrected EOB statement? My insurer deducted a provider discount for a provider who was NOT in the network. This caused me a lot of inconvenience because I had to determine who was right - the provider who was balance billing me or the insurer who processed the EOB as if the provider was in-network. After multiple contacts with the insurer and the provider, I finally was able to determine that the provider was correct, and I asked the insurer to send me a corrected EOB. So far, they refuse and they have told me to just pay the provider the amount of the discount. I realize I am responsible to pay an additional amount to the provider, but I feel I am legally entitled to have a document that correctly states my financial responsibility before I pay the provider. And, although the amount will be modest, I also know that the difference between the provider's charges and the maximum allowable fee will not be exactly the same as the provider discount. My financial responsibility to a non-par provider should be equal to the difference between what the provider charges and the insurance company's maximum allowable fee, plus any co-insurance amount. What can I do to enforce my right to receive a corrected EOB?

By: Guest
Date: Fri-May-27-2011-
Response
0

Answer 1

Your responsibility to pay is based on what your insurance says you should pay if the dr is contracted. Regardless of what the provider says, if the insurance has a contract with the provider, they cannot balance bill you. You need to contact the insurance and have them follow their balance billing protocol--usually they'll get in touch with the provider to have them stop their billing since they are in breach of contract.

Drs are generally the ones wrong in these situations--they have the contract so that people will go to them because they are in network, but then say they don't have a contract when it affects their payment...

Also drs will decide they don't want to be contracted anymore, and instead of notifying the insurance and cancelling their contract, they'll just start telling patients they're Out of Network. They have no idea why the insurance company doesn't magically know that they want to be out of their contract....

If they're really adamant about it, the provider should be calling the insurance to cancel their contract.

[d] By: Guest
Date: Unknown---
Response
What is 1 + 100



Helpfulbox Now Offers Free POS Software

for restaurants, kiosk, and any other retails business completely free. It can be used as windows cashier system or as full blown POS. You will able to print to kitchen, display orders on the kitchen screen, manage inventory, employee, report, customer loyalty offers, employee management, delivery address track and much more, all for free.

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