Refund from Dr.'s Visit in August?

Question

Back in August, I went to an in-network instant care clinic. I had a shot and strep test done, and they said I owed $152. They never did file my claim until I realized a few months later. When they filed with insurance, the amount due was only $85. Realize that this bill was already paid, but the insurance company is saying that's all that they charged since I have insurance.

I called up the dr.'s office to say I was owed the refund. They said the insurance company has to issue the refund. This doesn't make sense since I paid the $152 to the dr.'s office by credit card that day.

I have been dealing with 2 billing reps. by cell phone because they handle several locations, not just the Instant Care location I went to. One rep. quit, so another rep. took over in handing my stuff. It seems like she doesn't know what she's doing, so I don't know what to do now. I left a voicemail last week saying I'd file a complaint, but I don't know how to do that. Advice?

Answer 1

If the insurance company paid the claim to the care provider, and you also paid the care provider, then that means the provider was paid twice. and they do owe you a refund -- Not the insurance company.

If they are refusing a refund, call your insurance company and ask the service rep to call the provider's office for you.  If they are still refusing the refund, as if you can file a complaint with the insurance company against the care provider.

Ask your insurance company to mail you a copy of the Explanation of Benefits (EOB) for the claim. This should show that you owe $0 on the claim. Write a letter to the provider and include a copy of the EOB.  

When you can call your insurance company you can also ask the service rep to forward a case to their provider area (this is where provider represenatives make sure the providers do not breach contract).  I do not know if all insurance companies will allow you to file this type of complaint but it could not hurt to ask.