Let me see if I can help a little....
"2) can you get in writing the dates that the office was in network and the dates they were out of network? "
I'm sure the insurance company would have this information, the particular office may not.
"3) send the doctors office a written request that your chart and all documents signed by you, to be sent to you"
Original charts are not allowed to leave offices, however, they should be able to make you copies, some offices charge for that, some don't. You may be required to sign a records release form for the records as well.
"4) write down in detail as much information as you can remember. Receptionsist names, dates etc. Call your insurance company again and find out why they suspended that office for that time period"
Most of the time, it's not than an office was suspended, it's usually because the office dropped that particular insurance, then decided to renew the contract with that insurance company. Now, should that office actaully be "suspended" they may not be aware of that, the reason might be because they didn't get thier credentialing in to the insur comp on time, which happens alot.
"EXplain to the office everything that happened and how you were willfully mislead into accepting services from that office when they knew their office was suspended by your insurance company. Provide them with the details you find out about why they were suspended"
Not necessarily. Most offices do not, let me repeat, Do Not get a notice from an insurance company stating they are suspended....and unfortunately, go back through all of your insurance policy documents, it more than likey states that you are responsible for your insurance, that you are to keep up with what's covered and what's not. Most office require signatures stating that a patient is required to pay any amounts regardless of insurance covereages anyways. No insurance company, even when you the policy holder calls them, no insur company will guarantee coverage, only when they recieve the claims from the dr office, and it's processed, the insurance company will determine payment. Sometimes something really silly isn't covered, because simply thats the way that policy is written. It's up to the patient to know and understand thier insurance coverage. Most offices do not mislead anyone into anything, chances are, the patient didn't bother to call the insur company and make sure an office was in thier network before going in....a patient should always, always do this 1st!!!
And if a person was calling me saying...well I know your office was suspended for such and such reason, I would refer them back to our office financial policy and provide them with copies stating that they are responsible for all charges incurred regardless of insurance coverage. It doesn't matter why they were suspended. That's grasping at invisible straws.
I work in insurance and deal with this everyday. It's not fun. I hate when insurance doesnt cover something for someone due to the way a policy is written...it happens though...I try to get all documentation from the insur compy to the patient along with the bill, so in case they lost thier EOB, they still see why something wasn't covered.
I'm curious, is this a medical or dental office? Have you asked for your account printout from the 1st date of service? Did you save all EOB's (explainations of benefits- the paper that shows what the insurance comp paid the dr office) from your insurance company? If you don't have them, call your insurance company and ask them to resend them to you.
Hope this helps, if you have anymore questions, I will try to help....
=)
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