My insurance covers up to $10,000 for infertility services. My doctors office states in writing that they charge $4750 for one cycle of treatment. They have charged my insurance over $15,000 and maxed out my benefit for one cycle of treatment. On top of the insurance payments, they are billing me the difference between what they charged the insurance and what insurance paid. This amount is nearly their advertised cost for one cycle of treatment; so in total they are billing over 3 times what they advertised. The insurance has already paid them; is there anything I can do to contest what they've charged my insurance and what they are now trying to bill. I feel like it's fraud because it's not what they advertise.
You should bring this matter to the attention of a consumer attorney. There may be a way to pursue this matter depending on the documentation and billing related to this matter. I think that this would be more of a consumer related matter than a malpractice or negligence type of matter. Good luck.
Challenge the charge directly with the clinic and object to it with your insurance company. You need to object with your insurance company quickly to preserve your benefit for future use.
You need copies of everything you recover in writing regarding the price.
It will help you to obtain the services of a lawyer.
The thing to remember is that if you didn't have an agreement on price up front, all you have is an offer to negotiate. Your insurance company can retract payments they have made to the doctor, so your price has not been established yet. Act quickly and it won't be.
I disclaim everything and make no represention of the applicability or accuracy of anything I said here. You are not my client; i am not your attorney. I thought about making this disclaimer as a poem and quickly decided not to do so. Robert Frost can sleep easy.
The short answer is "it depends" on what your policy expressly says about the coverage, as well as what kind of policy you have (i.e., HMO v. PPO or EPO, etc.). You can certainly challenge the bills to you, but ultimately, the facts and circumstances will dictate whether you have a case against the provider.
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