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Dorthi

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I have a question and need an answer as soon as possible. Pretty sure i am going to be giving my notice today due to this but want to make sure i am right first.

We see patients for mva, we were paid by geico and the patient had a 78.00 co-insurance balance per geico.

When the case settled the attorney and our owner agreed upon a 500.00 payment and there is nothing that says the patient owes that. In the email i got it said the owner felt the reduction was incorrect so he and the attorney agreed on the 500.00 full and final.

I do not think this is legal or allowed because if he disagrees with the payment he would have to take it up with the insurance not money from the patient's settlement, correct? And if they reduction was incorrect, it was not 500.00 worth of incorrect.

They are telling me it is not illegal and that he is in the right accepting the 500.00 and i disagree and i am worried i should not stay in this office under the circumstances, i do not want my name on any of this as the billing manager.

Please any advise would be helpful. I really in a bad place right now with this.

Dorthi
 
No-fault laws/regulations vary by state. I found this out on the web which gives a general overview of the difference in various states:

https://www.naic.org/documents/prod_serv_special_nfs_om.pdf

Are you in FL? It appears to be one of the states that has patients responsible for a "copay". If so, per page 15, the Florida Insurance Dept. has a Division of Insurance Fraud which would be able to direct you. Here is a link to their website just in case:

https://www.myfloridacfo.com/division/difs/offices/


ETA: I think you should google your state's Insurance Department to find out what you can do
 
I am not certain I am understanding the issue. Are you saying the physician and the patient's insurance agreed to 500.00 as payment in full for medical services? and you feel this is incorrect? Please clarify what the problem is. And yes in most instances the medical is paid out of the settlement through the attorney, and the attorney will try to reach an agreement with the medical parties for the least amount they can get them to accept. Also once an agreement is reached it is usually a binding agreement.
 
No Geico paid 319.00 and patient responsibility was 79. The total was like 389 and some change. Then out side of that allowed amount the attorney and owner agreed to another 500.00 the patient does not owe us.
 
Was the full bill for the service rendered more than the 319 paid by Geico? I am assuming it was. The addition monies paid to the physician was a paid in full amount reached by an attorney with the full permission of the patient. the attorney would have known the amount of the bill and the amount paid by geico so I cannot imagine that anything illegal or underhanded has taken place. It all sounds very routine and above board to me
 
I agree with Debra, this doesn't necessarily sound suspicious but maybe I'm not understanding what your reservations are about it. This doesn't sound like a fraudulent or false claim type of situation, but perhaps at very worst a possible contractual violation if there was an agreement with Geico, which I think is unlikely if an attorney was involved. And even if the payments exceed the actual charges for the medical treatments, the provider could be within their rights to claim compensation for the time, paperwork and other expenses of being involved in the case. But at worst case, we're only talking about $500 here - I would try to keep this in perspective. A disagreement about an amount like this isn't really worth making a large dispute over or giving up a job for unless it is part of a larger pattern of unethical behavior.
 
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I think I understand what you're saying. The attorney and the owner agreed to a settlement of $500. The pt's insurance (auto) paid $379.00 w/ a pt resp of $79.00---It sounds like her/his insurance pd via her/his PIP and the attorney is paying via the settlement--If there's a balance left on the pt's acct; I'd satisfy the balance and return the rest to the attorney. At least that's what we do in MD.
 
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