Is it legal for a doctor's office to bill my insurance company for a missed appointment fee?

Question

I had called and left a message on the answering machine of my doctor's office cancelling my appointment awhile back. They charged me a $50.00 missed appointment fee anyway. I just received another bill for it, and it looks like they charged my insurance company for the visit anyway! Is this even legal?

Answer 1

I was told yes , the medical center where I go occasionally is now doing that. I heard one lady that went in said well if you charge me for that I am going to charge you for making me sit for hours waiting it is my time and my time is valuable too, I have cancer and am dying and so every second is precious to me. I heard when she comes in they take her right in now.

Answer 2

First of all...I'm sorry they did that, that's mean.

But no, it's not illegal. The doctor's office already knows that the insurance company isn't going to pay it. But they bill insurance because it gets your attention. Usually when you first fill out paperwork at the office, they'll have you sign something saying that if your insurance doesn't cover something, you're responsible.

That being said, they bill your insurance...but eventually they know you will have to pay for it because most insurances won't pay for a missed appointment fee.

Hope that helps :)

Answer 3

Welll, if they told the insurance company that it HAPPENED, the appointment, that's insurance fraud.  The insurance company won't pay a missed appointment fee.

Answer 4

I have seen many physicians state on the initial forms you sign when first seen, that you can be charged for missed appointments if 24 hours notice is not given. It is possible that your doctor is one of them. If he did bill your insurance for it, that is most likely not payable by the insurance and therefore you are being billed. No law was broken by his office for billing for this if it was billed as a missed appointment and not an actual office visit.

Answer 5

Yes its legal, no your insurance will not pay for it as no services were rendered, and yes, you will have to pay the bill, especially if you plan on seeing that same Dr. again. I know it sounds harsh and ridiculous, but I'm on the other side of this argument. I'm a physical therapist at an extremely busy practice. (I'm sure your Dr's practice is also very busy and hard to get an appointment.) We would have patients everyday that would not show up at all or even call to let us know that they weren't coming. As a patient you may not understand, but that affects our entire day. The ones who really mess up our day are the late patients. We eventually put up a sign that said patients had to call at least 4 hours ahead if cancelling an appointment or if you were over 15 minutes late, you would have to reschedule and also be responsible for a $50 charge that your insurance will not pay. It's not being rude or greedy. It affects the rest of our day when someone is late; the patients who show up on time then have to wait longer for their appointment due to only one person being late and we then have to work later. And when a patient doesn't show up at all, there could have been another patient put in that time slot. We would turn away on average 3-5 patients a day who wanted to make an appointment because we were full. When someone doesn't show up now all you have is lost revenue that could have been filled by a paying client. And honestly, we never followed through with it, but after we put that sign up, our late patients and no-shows dropped to almost non-existent. We have families too and would like to get paid and get home at reasonable hours. You think your just missing a Dr's appointment, but people don't realize that they are then affecting the Dr or PT, his nurse, office staff, other customers who were waiting that could have gotten in earlier had they known a patient wasn't showing up, and also affecting patients not even there, but who wanted to be and couldn't get in that day.

In your case, since you called and left a message on the answering machine, that is ridiculous that they are billing you. I would love if people would take the time to do that! And if they didn't check the machine that is their own negligence, why do they have one at all if they aren't checking it for patient cancelations? But I'm guessing they told you they never got it and sorry to say, it would be hard for you to prove. Or maybe they did get it, but you didn't call and leave it within their time limit. I agree with you that since you called, they are being harsh. But it is legal and it has cut back so much on no-shows and cancellations at the last minute.

Edit: Ok then, that changes everything. Since you didn't visit the office, they can't charge your insurance company for an "office visit". That constitutes insurance fraud and your Dr's office can get into some major trouble over this. I started to ask you earlier what the charge said on your letter from your insurance. I also was going to say I don't even know how they could bill your insurance because there was nothing to charge for. As I said above, they can charge you because that is lost revenue for them, but they can in no way charge your insurance company for it. Your Dr's office is a bunch of crooks who need to be turned in. I'm all for discouraging no-shows and getting people to cancel appointments in time for another patient to be put in that time slot, but what they did is not only unethical, but illegal. You need to call your insurance company first thing on Monday (maybe someone could help you on a saturday, but I doubt it) and give them your claim number and tell them they were charged for a visit that was never made and why they got charged. Your insurance company will call the Dr's office and get their money back, but you also need to call that office and tell them you're sorry, but its not your fault they don't check their machine and even if you hadn't left a message canceling, they cannot bill your insurance for an office visit because that is fraud. If they would have just sent you a bill for the $50, they would be within their rights, but they cannot charge your insurance for services that were never rendered. I would send a letter to the clinic administrator and let him/her know what one of their Dr's are doing. Oh, and another thing, please find another Dr.! Preferably one that doesn't commit fraud.

Answer 6

Yes. it's done all the time....the greedy b******s.  Let the Ins company resolve it.