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Medical bill question.

Can a Doctor bill you for an emergency room consult when they dont accept your insurance? The hospital called them not me and the ER does take our insurance. My insurance says they have to bill them. It was an emergency and they will cover it But the Doctors office refuses to bill them. I can pay them. But my insurance wont reimburse me. Because they would pay the Doctor if they would just bill them. What do you know about this?

Answer Question

Asked by martinmommy26 at 6:02 PM on Oct. 6, 2010 in Money & Work

Level 16 (2,752 Credits)
Answers (8)
  • Doctors are under no obligation to bill any insurance company for any patient. It is considered a "courtesy". You can bill your insurance though. If you get the ICD-9 and CPT codes, you can bill your insurance company yourself.

    Is there a reason why they won't reimburse you? It sounds like they're trying to get out of paying.

    Answer by corbysmom531 at 6:13 PM on Oct. 6, 2010

  • They just dont do it at all. But the Hospital has told me I should not have gotten a bill. Because he was on call with them. Not working from the office. So I am lost.

    Comment by martinmommy26 (original poster) at 6:16 PM on Oct. 6, 2010

  • if the dr. sent you a bill, then they need to provide you with the means to get reimbursement from the insurance company. icd-9?, hcfa?, superbill?, statement on letterhead with dr's name and numbers, services performed, and diagnosis codes.
    it sounds like whoever you spoke with at the dr's office was not trying to help you.
    try to call back, stay calm and ask them what you need from them to get paid by your insurance company.
    you could also phone your insurance company again, and ask if you could just submit the dr's statement to them. it may be that the insurance company will only pay you, once you have paid the dr.
    it makes me so mad when people have the means to help you but don't.

    Answer by happy2bmom25 at 6:30 PM on Oct. 6, 2010

  • Thank you. They are being very unhelpful. Never asked in the ER if they took out insurance. The ER doctor tried to release my son and the specialist wouldn't till he say him.

    Comment by martinmommy26 (original poster) at 6:44 PM on Oct. 6, 2010

  • Make an copy of the bill and send it ti your insurance company. I have never heard about the doctor or hospital not wanting to get paid. As long as they get paid it shouldn't matter. Who's paying the bill.

    Answer by TwannaB. at 10:42 AM on Oct. 7, 2010

  • Of course the doctor has to bill you. Changes are what will happen is you will have to pay him and your insurance company will reimburse you.

    Answer by HotMama330 at 12:28 PM on Oct. 7, 2010

  • After talking to the hospital today, The ER doctor had not called the specialist. He found my son on the computer. So he was not called by anyone and The hospital and insurance have both filed a grievance against the office.

    Comment by martinmommy26 (original poster) at 1:02 PM on Oct. 7, 2010

  • After reading more info, I wouldn't pay that specialist. Let them send you to collections if they want, I would fight it. You didn't ask for his services, the ER dr didn't ask for his services, so you don't owe him anything if all he did was look at the chart and your son.

    Answer by corbysmom531 at 2:51 PM on Oct. 7, 2010

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