Can doctor’s office receive payment from a patient and their insurance company for a single visit? Is this double billing and insurance fraud?

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Can doctor’s office receive payment from a patient and their insurance company for a single visit? Is this double billing and insurance fraud?

I have a health care reimbursement account through my insurance company. I went to the doctor on May 20th. They said they do not accept health care reimbursement accounts and I had to pay for the visit. They billed my insurance company and the insurance company paid 100% of the bill with funds in my health care reimbursement account. The doctor’s office has been paid twice for services render on May 20th. The doctor’s office received payment from the insurance company over a week ago. They have not refunded my portion. What are my options?

Asked on June 22, 2009 under Insurance Law, Oklahoma

Answers:

B. B., Member, New Jersey Bar / FreeAdvice Contributing Attorney

Answered 11 years ago | Contributor

You should get whatever you paid in person on May 20th refunded, absolutely.  I'm not surprised that you haven't gotten the money back, because a week isn't a terribly long time in a situation like this.  I'd start with a polite telephone call, asking when you can expect to see the money.  The next step would be a letter (ideally certified, return receipt requested), again polite, with a copy of your receipt from May 20th and a copy of the statement you got from the insurance company showing that payment.

If that doesn't work, talk to a lawyer in your area.  There are differences in the law and procedure from one state to another, and I don't practice in Oklahoma;  also, all the facts of your case can be important, and your attorney will need that information to give you reliable advice.  One place to look for a qualified attorney is our website, http://attorneypages.com


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