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PostPosted: Tue May 22, 2012 8:02 pm 
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Hi I was looking for someone to answer my question on the internet, and found this forum, which I am pretty relieved about.
So here is my issue, I Just started going to a new suboxone clinic , I was in a different one before but my doctor kept cutting me down, even though i protested every time, and told her i wasn't ready to taper consistantly. The new place seemed great, they listened to my concerns so far, and have been very helpful, I have insurance, and the first day i went in which was abouta month ago, I was told they did not accept any payment or insurance, except cash, I thought it was strange but paid anyway. Well then they asked me for a copy of my insurance card to "pre authorize" with the pharmacy, i gave it to them, and didn't really think anymore about it until i realized they didn't ask me which pharmacy i was even going to use.. anyway, after paying a pretty good sum of money, i thought things were just fine, until i looked at my insurance claims on the internet. everytime i have had an appointment, and paid cash, because they did not take insurance, they charged my insurance too! by my count they are making double what they even charge there....and they "don't accept insurance" so i still have to pay cash every time. i haven't mentioned this to them, because they have been really good to me so far, and i fear them making me leave without my medicine and that would be terrible, i really don't know what to do.. does anyone have any suggestions on a good way to handle this?


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PostPosted: Tue May 22, 2012 8:17 pm 
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I'm nearly speechless (and most people here can tell you that's rare...lol). Wow, let me think here. Do you have receipts for all those cash payments to them? KEEP THEM. Did you sign a contract and if so does it say in it that they only take cash? Or anywhere in any other paperwork does it say they only take cash? Signs on the walls, anything? If that's the case, then I'd say it's clearly insurance fraud. That's obviously way outside of a misunderstanding. I'd say it's up to you how you proceed from there. And this is only my opinion. I'm not a lawyer or a law enforcement professional. You obviously can report him or confront him directly.

This is just how I see it.

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PostPosted: Tue May 22, 2012 8:27 pm 
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First, thanks for your opinion! I can't find anyone to talk to about this, I do have my receipts, they printed them out for me. I also have access to print the claims they filed with my insurance company, with dates and all that information. I Looked through the papers they made me sign, and I can't find anything in there about them only taking cash, but it does say how much I am supposed to pay per month, including intake fees and all that, and with my insurance paying them, and cash, it has almost double exceeded the price I signed to pay. I am just kind of torn here, because other than this, its been a great place to go, well, for the short time I have been there. I don't know, the only thing I really would like, is if they would just take my insurance and let me pay the copay, instead of a matching cash payment as well which is almost 300 bucks, opposed to the 50 dollar copay I should be paying.. I don't want to make them mad because I am afraid they will just kick me out, and it was hard enough to find this place, and get the intake fees and all that.. ugh.. I wish everyone thought honesty was the best policy! I mean.. all I want is for it to be fair, I don't want to like sue them, or report them or anything, or cause any trouble, I am a pretty passive person, but, it is kind of awful. Basically I was just looking for a good way to bring it up without being aggressive or sounding unreasonable.. I really don't want to get kicked out and have to start over.


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PostPosted: Tue May 22, 2012 8:48 pm 
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You can always go to them with the assumption that it was a mistake. The left hand not knowing what the right hand was doing. Hell, maybe they just started taking insurance or something. Who knows! Anyone can rationalize anything if they really want or need to. They will likely feel at your mercy, knowing full well you COULD turn them in at a moment's notice. You have them by the balls and they will know it. I would think they would be open to refunding your money and meeting the rest of your terms - 100%.

I don't blame you at all for wanting to handle it this way. You'd be opening up a big mess. You'd have to get a new doctor, be involved in a long, drawn-out insurance fraud case, yada yada. I understand not wanting to report him for all those reasons and more. You're the only one who can make that decision. Remember, though, you can report him to the insurance company anonymously...Because if he's doing this to you, he's doing it to others as well.

Good luck with your decision.

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PostPosted: Tue May 22, 2012 8:58 pm 
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halleyzcomet wrote:
Hi I was looking for someone to answer my question on the internet, and found this forum, which I am pretty relieved about.
So here is my issue, I Just started going to a new suboxone clinic , I was in a different one before but my doctor kept cutting me down, even though i protested every time, and told her i wasn't ready to taper consistantly. The new place seemed great, they listened to my concerns so far, and have been very helpful, I have insurance, and the first day i went in which was abouta month ago, I was told they did not accept any payment or insurance, except cash, I thought it was strange but paid anyway. Well then they asked me for a copy of my insurance card to "pre authorize" with the pharmacy, i gave it to them, and didn't really think anymore about it until i realized they didn't ask me which pharmacy i was even going to use.. anyway, after paying a pretty good sum of money, i thought things were just fine, until i looked at my insurance claims on the internet. everytime i have had an appointment, and paid cash, because they did not take insurance, they charged my insurance too! by my count they are making double what they even charge there....and they "don't accept insurance" so i still have to pay cash every time. i haven't mentioned this to them, because they have been really good to me so far, and i fear them making me leave without my medicine and that would be terrible, i really don't know what to do.. does anyone have any suggestions on a good way to handle this?




Hi Halleyzcomet and welcome.

I too, have a Dr. that will not take insurance , only cash. So each time after my dr. visit i ask for my receipt so I can file on my insurance to be reinbursed for the amount I paid the subdoc. Have you ever asked for a receipt to file on your own insurance?? If not you might try that and see what happens...if they know you are filing as well, they would probably not double file. But this is against he law! My doctor's office also asked me for my insurance card and I said no.whydo you need it, you are not filing on it??? And that was the end of that!!!

Slipper

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PostPosted: Tue May 22, 2012 10:43 pm 
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I would report it to my insurance company rather than confronting the doctor about it. The insurance company will be on it because they don't want to have to pay for anything if they don't have to pay for it. Just my two cents.

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PostPosted: Tue May 22, 2012 11:08 pm 
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Thank you guys so much for your opinions, I really appreciate any advice on this at all, as I am lost about what to do!
Slipper: I did file a claim, that is actually how I found out about it to begin with, they gave me a form, and I was checking the status of my claim online and noticed other claims, for the only dates I had seen the doctor. My insurance company applied my claim to a deductable, but paid theirs. They actually filed it under a default provider, I guess incase I noticed or something? but the dates and prices matched up exactly,and I hadn't seen any other doctors or been to the hospital so it definitely didn't take long to figure it out.
I think that I may take my receipts, the papers I signed with how much the visits are, and the printed claims they filed for my next appointment, and try to say something along the lines of "guess what my insurance works here now" I don't want to be too confrontational, as there aren't many clinics where I live and I don't want to have to start over, or get them investigated. Hopefully that will end up fixing the situation, but if anyone has any other comments or ideas, I would definitely love to hear and consider them, I have about a week and a half to figure out my game plan... lol Thanks again!


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PostPosted: Tue May 22, 2012 11:08 pm 
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Dr. J may be interested to know this as well...


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PostPosted: Tue May 22, 2012 11:37 pm 
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If I were you, I would definitely take your situation to court, because it sounds like fraud to me. That is so incredibly messed up on your so called "doctor's" part. Good luck and I hope you get this dealt with.


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PostPosted: Tue May 22, 2012 11:41 pm 
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halleyzcomet - From reading your posts I get the distinct impression that you don't want to turn your doctor in, is that correct?

If that's the case, then I won't push you. You know what he's doing and it's your decision to make.

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PostPosted: Tue May 22, 2012 11:50 pm 
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Hatmaker-
It isn't that I don't want to turn that doctor in specifically, its that if I did that I would be on the search again possibly without the medicine, and I feel like now is not a good time for me to not have it until I find another doctor, or more money for intake fees or both. I know that may seem somewhat selfish of me, since they are probably doing it to others too, I just don't have an extra 500 or so to start over, or the time to wait I don't think that would be a good step to take towards recovery. This medicine has done amazing things for me so I don't want to lose it, even temporarily, I don't think I am strong enough to stand on my own without it yet, so thats really the main reason, plus like you said, it would be a big mess with court also, if it were to go that far, not to mention, I feel like I would be costing all the other people that go there their possible recovery if the place were to get shut down. I don't know.. it's a lot to think about... I am hoping that me just bringing in the documentation and nicely letting them know I am aware will stop it where it stands, I am just trying to figure out how to do that in the best possible way, I suppose.


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PostPosted: Wed May 23, 2012 12:04 am 
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My doctor did the exact same thing to me. For a good while, it was all cash payments, then one day they asked for my insurance info and then they started hitting my insurance AND taking my cash payment. Obviously, it made me about as mad as a hornet, so I showed everything to my wife, who is a human resource manager and she said everything was legit?? I almost feel over when she said everything was legit, but somehow it was.

Like DoaQ said, if you have any questions, I'd go through my insurance company. I remember my wife talking about EOB (explanation of benefits)??

Good luck.

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PostPosted: Wed May 23, 2012 12:10 am 
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Romeo is correct. You can easily go over the Explanation of Benefits that your insurance company sends to your for every bill they pay. It shows dates of service(s) and amount(s) paid. If it's on the up and up, then the amount on your service date will show the amount the insurance paid AND the cash amount you paid (or were responsible to pay), reflecting the total payment that the doctor is billing for his service on that date. That should match what he contracted with you to charge for each visit.

Good catch, Romeo, I didn't even think of that.

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PostPosted: Wed May 23, 2012 12:40 am 
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Thanks Romeo and hatmaker for all of your help and advice, here is the thing I don't want to give out real rates but lets just say I signed a contract at 500 dollars a month, and it was cash only they said they could give me a form to try and get my money back but they did not accept and could not use my insurance ...now I gave them 500 in cash upfront and they also charged my insurance another 500 behind my back to my count that is 1000 ...double what the contract said I needed...not to mention they told me like 25 times there is no way they would use my insurance because they couldn't ..but it's definitely on there..I looked at my explanation of benefits online and it's all pretty plain... I am hoping maybe they did just start taking insurance but they sure didn't mention that to me last time I paid...in full...


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PostPosted: Wed May 23, 2012 6:17 am 
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Romeo is talking about the EOB, which means explanation of benefits.

Now, even though they don't accept your insurance, they can STILL file it for record purposes on your insurance, even though it's rejected.
Look at these two pictures, the FIRST is a claim on my insurance from an IN NETWORK doctor that accepts my policy.

The SECOND is from MY DOCTOR, who DOES NOT accept my insurance, and the claim they submit to BCBS isn't paid until I meet a deductible...this is why they file it. Once I meet that deductible, they WILL pay a certain portion...
So check again and make sure they are actually being PAID something, just because they SUBMIT the claim doesn't mean they get PAID for it. BE SURE!!!

I've circled the proper columns you should look for on your own EoB:

Image

now this one:

Image

You see the second one where it says I've paid $273.00 of my $300 deductible? That means once I hit that, the insurance WILL pay the doctor something, whereas on that claim, they got paid NOTHING of the $195 they submitted to insurance. The eligible amount was $95, but since I haven't yet met my deductible, they didn't get that part.

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PostPosted: Wed May 23, 2012 3:20 pm 
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Jonathanm -
Thanks for going through all that trouble to show me what you meant. Afterwards I did look at my insurance again, and they are definitely being paid a matching amount from what I am giving them in cash. In fact, it says that my co pay is only 50ish dollar range,(can't remember exact numbers) and not the 300ish I have been paying. I am 99 percent sure they are getting double paid....I have looked through everything, and it seems to me for the 500 dollarish first month bill, they have received close to 1000 dollars. (again, I don't want to put in exact numbers for identification reasons...) thanks everybody for all of your help I really appreciate all of the insight and ideas and explanations.


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PostPosted: Thu May 24, 2012 8:34 pm 
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i read this and was like damn my clinic also asked for our insurance card to pre-authorize the pharamcy thing. so i immediatly went and signed up and then logged in to check our claims. thankfully we are not being double charged. my husband has the insurance that covers us both, but the doctors office we go to does not accept insurance for the sub program -cash only. wish you the best in dealing with the matter you need to handle.


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PostPosted: Fri May 25, 2012 1:41 am 
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Wisharer
Glad it's not happening to you also it's an awkward situation to be put in for sure! They are definitely getting paid twice still don't know how I'm gonna handle it but hoping someone will post what I think is the best way or it will just come to me in the middle of the night lol you wouldn't think it would happen in a professional medical setting but I suppose it does bc it's definitely happening to me.


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PostPosted: Sat May 26, 2012 10:26 am 
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my sub doc doesnt use my insurance either and i pay cash.. my question is can i take my reciept and file it with my insurance company for reinbursment? wow that would be nice


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PostPosted: Wed May 30, 2012 11:32 pm 
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I am going back to the dr really soon, anyone have any last minute suggestions on how to bring this up politely?i have printed copies of my recipts and insurance claims also. Thanks in advance


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