Can/how do I sue my OB office? (kind of long)

hterry85 · July 2011

Here's the short version:

When I was pregnant with DD I had insurance through my employer with a high compay/deductible. I was pre paying my OB office for the delivery. Durng that time (before she was born) I got a secondary insurance, and would no longer owe that amount I had pre paid. I work in insurance and understand that they had to bill those charges to my insurance (meanuing she had to be born first) before they could reimburse me, Fine. I knew this would take awhile so I waited a few months after she was born before I even started asking. They would tell me that they would look into it....then nothing.

FINALLY this March (DD was 13 months by this time) I get through to someone. Well, basically I wasn't getting off the phone.. she was going to have to hang up one me if she wanted out of talking to me anymore. Basically they had switched records systems, and the cards for my secondary insurance had not trasfrerred, so the insurance was never billed. Not my problem. I did get a check for a portion of what I had paid because it was too late for them to bill the insurance by this time. I was told the remaining amount (still several hundred) could still be billed, and I would get a check once they had gotten payment.

I was in earlier this month and asked about it...they now say I've gotten everything back I'm going to. They've given me about 6 different reason I'm not getting it back. Currently it's because they say I didn't have my secondary insurance until 11/09 so the money I paid is applying to services from 09/09 they denied. (due to not having coverage) They refuse to show me the EOB that says this. Yesterday I brought them a letter from my isurance stating that I did in fact have coverage for that time. They told me too bad and asked me to leave.

I've contacted the state insurance commisioner to find out exactly who to file a complaint with. And I'm currently trying to get my own copies of EOBs, but the insurance companies aren't much more helpful.

I know just a phone call or a letter from a lawyer sometimes will get them to change their story. What kind of lawyer do I need to talk to, and what info should I have ready? Any other suggestions?

kes3237 · July 2011

Why can't you just file a claim with your insurance company for the services that you've paid the provider for? I hope I read your post correctly.

hterry85 · July 2011

kes3237:
Why can't you just file a claim with your insurance company for the services that you've paid the provider for? I hope I read your post correctly.

The most recent person I talked to (going to try again) told me that they don't reimburse. IF a claim was denied incorrectly, it would be up to the provider to resubmit/dispute.

kes3237 · July 2011

So it seems both the OB and the Insurance company are giving you the runaround. That sucks. I don't know if I fully understand your situation but two things strike me as strange: not providing you with an EOB and not reimbursing the member for a prepaid claim. Both of these seem standard to me. Do you have insurance through your company? Is there a rep there that can help you?

groovygrl · July 2011

I'm totally confused by your story (it sounds like they paid you back some but not all is that right? I don't know what part it is that they haven't paid back).

You should have your EOBs, insurance co's send them to the subscriber (if you don't call & request them to be resent), so what I would do is line up ALL that paperwork and write up a brief timeline of what was paid & not paid, every conversation you had from insurance co & provider office including names, dates & info given, do a spreadsheet in excel so you can show the various balances & illustrate why you are still due money, photocopy & submit to the provider/billing office explaining what you feel you are due and if they continue to deny it, you will seek counsel about how to proceed.

GL!

hterry85 · July 2011

groovygrl:

I'm totally confused by your story (it sounds like they paid you back some but not all is that right? I don't know what part it is that they haven't paid back).

You should have your EOBs, insurance co's send them to the subscriber (if you don't call & request them to be resent), so what I would do is line up ALL that paperwork and write up a brief timeline of what was paid & not paid, every conversation you had from insurance co & provider office including names, dates & info given, do a spreadsheet in excel so you can show the various balances & illustrate why you are still due money, photocopy & submit to the provider/billing office explaining what you feel you are due and if they continue to deny it, you will seek counsel about how to proceed.

GL!

Yes, I have gotten some, but not all back/

My secondary insurance is through the state. It's one of those programs anyone can get, it's just that your premiums, copays, etc are determined by income. I have never seen an EOB from them. The person I talked to (the same that said they don't reimburse) did not have the EOB information, and said that they only talk to providers. There was no way for me to get that information. I agree that this doesn't sound right. I plan to try again with them today. I'm also going to check with my primary to see if by chance they have any info/can help me out.

Oh, and the secondary has sent me the paperwork for an investigation into it, but I have to have been sent to collections or something. Since I pre paid, I obviously have not.

AllieKruse · July 2011

If your claim is under $7500 I would just drop it. We were/are going through the process of getting an attorney to sue the previous homeowners for non-disclosure for leaking windows, but it will cost at least $7500 to take it through court-- and this doesn't guarantee we will win (this recommendation was made by our lawyer).

SLHurst11 · July 2011

Just call any popular law firm in your area. Generally, an initial contact with a paralegal is free.

junebug02 · July 2011

Is there an office manager or the OB him/herself that you could escalate the issue with?

workingmama · July 2011

AllieKruse:
If your claim is under $7500 I would just drop it. We were/are going through the process of getting an attorney to sue the previous homeowners for non-disclosure for leaking windows, but it will cost at least $7500 to take it through court-- and this doesn't guarantee we will win (this recommendation was made by our lawyer).

Your lawsuit's costs could -and likely would - be very different from OP's.

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Can/how do I sue my OB office? (kind of long)

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