Wife’s OBGYN had us pre-pay for prenatal care and delivery, closed his practice before they sent deductible refund (doctor, insurance)

[mjedwards409]

TLDR at bottom.

Title pretty much says it all. Our 3rd baby was born in December, and this OB had delivered all of ours. Their office had always had the prepayment policy, but inevitably the hospital would file with insurance first, so her doctor would always end up refunding us most of the money because we had hit our deductible. We usually got it back in 2-3 weeks, and it was never an issue. With this one, we were chasing them for about a month and a half for the $1,700 in overpayment they owe us, which was very unusual. A few days ago I called the office, ready to demand an explanation and insist we get our funds ASAP considering they committed the refund a month ago, and I get an “after hours” message from their line in the middle of the day. Did a little bit of digging on social media, and it turns out the doctor suddenly closed his practice.

No notes on the main webpage, nothing on the voicemail about it, Google still says they’re open, etc. I have the doctor’s cell, who finally responded once and says that Suzie (not her real name) would take care of it. The fun part is, I talked to “Suzie”, who said that she was no longer employed there and did not know what he was talking about.

Long story short, I called my insurance company (UHC) and told them the story. They confirmed that the doctor is still under contract with them, and that they would support me if legal action is necessary because the doctor was clearly overpaid according to our plan. They said they would give him some time to respond first before escalating. I’m trying to get them to put some heat on it, because it seems there are certainly some red flags with how he’s acting.

Anything I should be doing now besides getting insurance to pursue this? Another question – if he declares bankruptcy, are we in danger of never seeing this money, or not seeing it for a very extended period of time?

TLDR: OBGYN made us prepay for wife’s prenatal care/delivery. Owed us $1700 for deductible overpayment. Closed doors after already agreeing to reimburse, but never did. Red flags like no notice on website, nothing about being closed on voicemail, still shows open on Google, referring me to terminated employees. Insurance company involved. Am I screwed if he declares bankruptcy?

[bande1102]

You had a $1700 deductible with your insurance plan?

The insurance company applied that deductible to a provider other than the doctor your prepaid? Did you pay the deductible to the hospital?

OR

You actually did not owe the $1700 to any provider?

[mjedwards409]

Originally Posted by bande1102

You had a $1700 deductible with your insurance plan?

The insurance company applied that deductible to a provider other than the doctor your prepaid? Did you pay the deductible to the hospital?

OR

You actually did not owe the $1700 to any provider?

We have a $2,400 deductible. (High deductible, low premium plan, so I can contribute to HSA)

The insurance company applied the deductible for payments we made to the actual hospital, because the OBGYN didn't actually file the claim until AFTER the birth, and by then the deductible had already been met.

So we paid $2,800 to the OBGYN halfway through the term, $1,100 of that is rightfully theirs because of some leftover deductible as well as co-pay, and $1,700 is owed back to us.

[bande1102]

Originally Posted by mjedwards409

We have a $2,400 deductible. (High deductible, low premium plan, so I can contribute to HSA)

The insurance company applied the deductible for payments we made to the actual hospital, because the OBGYN didn't actually file the claim until AFTER the birth, and by then the deductible had already been met.

So we paid $2,800 to the OBGYN halfway through the term, $1,100 of that is rightfully theirs because of some leftover deductible as well as co-pay, and $1,700 is owed back to us.

Basically, the doctor was paid twice: by you and the insurance company.

I would contact the insurance company and tell them that they overpaid this doctor and they need to recapture that overpayment and credit the hospital. Alternatively, the insurance company could send you check in the amount of the overpayment to the doctor. Of course, I would send proof of payment to the insurance company.

I would contact the hospital and explain the situation. The hospital should have a financial aid office or patient advocate who might be able to help you. I'd start there.

I would also contact my state insurance commissioner. Most have a form you can complete online. Again, the insurance company overpaid the doctor. You met your out of pocket responsibilities.

[mjedwards409]

Originally Posted by bande1102

Basically, the doctor was paid twice: by you and the insurance company.

I would contact the insurance company and tell them that they overpaid this doctor and they need to recapture that overpayment and credit the hospital. Alternatively, the insurance company could send you check in the amount of the overpayment to the doctor. Of course, I would send proof of payment to the insurance company.

I would contact the hospital and explain the situation. The hospital should have a financial aid office or patient advocate who might be able to help you. I'd start there.

I would also contact my state insurance commissioner. Most have a form you can complete online. Again, the insurance company overpaid the doctor. You met your out of pocket responsibilities.

Thanks so much. I called the insurance company for the fourth time, very firmly this time, and let them know that I have fulfilled my obligation for deductibles, out of pocket, etc for their IN-NETWORK provider, and I absolutely expect a reimbursement from them if we can't reach the doctor. Not surprisingly, they gave me the line that "the doctor owes us, they'll try to help me track him down, we hope you get your money, etc". I fought with them for about 90 mins with continual threats to file a complaint with my State Insurance Commission, and eventually they agreed to escalate it to one of their "Network Heads", whatever that means. To be honest, I have no idea how much leverage I have here, if any, but I'm certainly going to make a lot of noise.

[bande1102]

Originally Posted by mjedwards409

Thanks so much. I called the insurance company for the fourth time, very firmly this time, and let them know that I have fulfilled my obligation for deductibles, out of pocket, etc for their IN-NETWORK provider, and I absolutely expect a reimbursement from them if we can't reach the doctor. Not surprisingly, they gave me the line that "the doctor owes us, they'll try to help me track him down, we hope you get your money, etc". I fought with them for about 90 mins with continual threats to file a complaint with my State Insurance Commission, and eventually they agreed to escalate it to one of their "Network Heads", whatever that means. To be honest, I have no idea how much leverage I have here, if any, but I'm certainly going to make a lot of noise.

Good for you. Make sure you document the phone calls with dates and times. I would also send them a certified letter (usually there's a claim complaint/resolution address). I would submit copies of proof of payment and I'd also indicate that I was filing a formal complaint with the insurance commissioner....and I would. The more time that passes, the more difficult it is to resolve.

[mjedwards409]

I also talked to AMEX who said that I could file a dispute since I paid this 100% on credit card, as long as I had documentation from United HC with how much I owed. Worth trying that approach simultaneously?

[k7baixo]

Originally Posted by mjedwards409

I also talked to AMEX who said that I could file a dispute since I paid this 100% on credit card, as long as I had documentation from United HC with how much I owed. Worth trying that approach simultaneously?

Of course. They’ll issue a temp credit while they review your case and if the decision stands, it’s over. Much easier than trying to get a refund otherwise.

[bande1102]

Originally Posted by mjedwards409

I also talked to AMEX who said that I could file a dispute since I paid this 100% on credit card, as long as I had documentation from United HC with how much I owed. Worth trying that approach simultaneously?

Yes, I would definitely try that.

[ss20ts]

I'd contact an attorney.