I am having a problem with an eye care office. Even the doctor said it was covered, what should I do now?

Question

I am having problems with a eye care place I went to 4 months ago. The eye Doctor wanted to do extra tests on my eyes. I wouldn't have it done unless it was covered by my insurance. After they double checked they said I would just need to pay the $5 co-pay. The day of the appointment I told them again to make sure Because I would not have the test done if its more than the $5. I have now received a bill for $160.00 that I am fighting, VSP even called them and they said they talked with someone at the doctors office and they said it should be covered, but they were not the billing dept. and that person would call me monday I am still waiting and when I call the person is never in. I just got another bill for the $160. I live in California and am about to write to action line. Any advice would help.

Answer 1

Unfortunately it is your responsability to know what your insurance covers, not the Doctor's office. Depending on your coverage iwth VSP, you might or might not be covered by "Primary Eyecare" for medical proceedures such as extra testing. I feel that what your Doctor's office has done is not right either, in that they should have given you the chance to come back at another appointed time for extra testing so that clarification of your insurance benefits could be made. If they were medical in nature, it might be your health insurance that needs to be billed and not VSP. If VSP is telling you that it should be a covered item, then you need to ask if they were billed for that proceedure. Do not pay on the invoice. Call VSP and get all the information and see if they actually billed for that service. Call the Dr. Office on tuesday and CALMLY exlain that you need to talk to the office manager. Write the name of the person you speak to down and that date and time. Tell them that you are trying to resolve a billing issue. Do not use the word "fighting". Explain that you were told that this was a covered service and that you talked to VSP and give them the VSP person's name adn tell them what they said. Ask when they billed and if there was an EOB from the insurance that denied payment. See if they billed your regular health insurance as well. Get all your info straight before you get negative with them. Explain that you have been waiting for a call back and have not recieved one. Tell them that you are not in a position to pay on this invoice at this time , just like you stated on the day of your exam, and that you want to make sure that they have billed the insurance correctly before you take further action. If you get no satisfaction then call your insurance company and aks them where to go from there. I bet you can get it resolved, though using a bit of honey and not so much vinegar. They would rather get paid, than not, and they might be as frustrated as you are. Most Dr's only do extra tests that are indicated and do not try to just do things that they feel will get them money. So, do your homework and speak to them nicely. Just becuase they keep sending you a bill does not mean you owe it. But try to take care of it correctly and ask them to meet you half way by doing the same. I bet you get it taken care of.

Answer 2

Doctors are in the business of treating patients, not pocketbooks.  If you needed "extra testing", I can absolutely guarantee you that it was something VSP doesn't cover, no matter what they say.  The idiots at VSP will say all kinds of things are covered that aren't.  Basically, all they cover are ROUTINE exams.  Anything beyond getting a tweak in your prescription will NEVER be covered by them.  I hate VSP.  They are NOT medical insurance.  They are a discount eyewear plan, nothing more.

Now, I have no idea what the testing was for, but as a doctor, sometimes we just have to do it and hope it gets paid for, either by insurance or the patient.  If I left the decision up to patients, they'd pick their wallet over their health every time and at some point, I know what's in my patients' best interest.  

Do you have medical insurance? Was your testing billed to them?  Did the charges go towards your deductible?  If so, that's not the doctor's fault.  We don't always know what your deductibles are and if you've met them or not.  We're not the insurance company and we certainly can't be expected to know the ins and outs of every insurance plan out there.  Dealing with insurance is a lot of the reason health care costs so much these days.