I visited a doctor in August of 2015 that was in-network. They required me to pay for the services up front (in cash, btw). I should have known that was the first red flag, but I needed a prescription refill fast.
It's now January of the following year and my insurance and I have yet to receive a claim from the doctor's office. I tried submitting the claim myself to my insurance for reimbursement (I have a HRA through my place of work that reimburses me for 100% of my in-network services), but they cannot reimburse me without pertinent info from the doc (such as diagnosis codes, tax ID number of the doctor, an itemized receipt, etc.) I should not have had to pay upfront per the doctor's contract with Cigna, but they forced me to. Again, I shouldn't have paid, but I figured I would be reimbursed down the line.
I've tried calling and emailing both the doctor's office and my insurance 20+ times combined over the past 5 months to resolve this. Each time, the doctor's office says "We cannot control when our billing department submits the claims". When I pressured them, they lied and said "Oh our billing department sent that out last month". They also hang up on both myself and my insurance company when we call them.
My insurance company seems to only provide assistance in the form of calling the doctor's themselves and asking them to submit the claim per their contract (90 days in NY, I believe. It's been 5 months...)
I'm wondering the following
- What more can I be doing?
- Is this legal? I'm aware that doctors don't have to submit claims for patients, which is why I did it myself months ago. However, I can't be reimbursed until I have the other information from my doctor. Which they won't give me or send over.
- What websites, organizations & outlets can I report this to? I don't want any other poor soul to have to deal with this doctor and their negligence. I've already filed a formal complaint with my insurance company as well as ZocDoc (which is where I found this original doctor from), but nothing seems to really impact this doctor's office and make them change their ways.
Any other tips/horror stories would be helpful as well. Thanks!