Wow. I paid my cost share, my insurance paid the "allowable."
B sent me another bill for the balance. I contacted my insurance co. They sent her a letter outlining her contract and the fact she agreed not to bill the difference. They also said:
"Our files show you are a network provider, which means you cannot bill a beneficiary for non-covered care unless you inform the beneficiary in advance that we do not cover the care. Also, the beneficiary must waive his or her right to hold harmless by agreeing in advance in writing to pay for the specific non-covered care. Please note that general agreements to pay, such as those signed by the beneficiary at the time of the initial visit or admission, are not evidence that the beneficiary knew specific services were excluded.
We have no evidence indicating that you advised the beneficiary this was non-covered care, or that the beneficiary agreed to pay for the non-covered care in advance of receiving it. Since we do not cover this benefit, the full amount is a contractual write-off for you. If the patient paid for these services, please refund the payment to them within 30 days from the date of this letter."
So after she received their letter, she sent me this one. Received it today.
So I called my insurance co. again today. They told me not to pay the difference. That the service was covered and she has a contract with them that she won't charge the difference, and she's violating some federal law for accepting insurance and then trying to claim more than 115% of the allowable. (Not to mention I had the wig in my possession before they ever mentioned price, so I was not "informed" before receiving the service. Obviously she reads it as I have to be informed before my insurance is billed.)
The order form I signed the day all this happened says this:
"I understand that if I choose a wig that is priced higher than what my insurance allows, that I agree to pay the difference. This applies to all insurance companies."
I signed that the day I received the wig, after having it on, cut to fit my face, and was leaving ... after they demanded full payment up front or signing that if I wanted to leave with the wig.
My insurance co. says it's not legal. (There's a specific waiver form that has to be filled out for non-covered services and this isn't it.) So they are contacting her again, and if she pursues this, they will perform a query (and still might) of all their beneficiaries who received service from her before (the ones wig girl told me paid the difference).
Shesh. I see now why people just pay. To shut her up.
We have insurance through our military retirement (no it's not free!). But if she gets black balled from it, she will also lose her Medicaid contract according to the insurance supervisor I spoke with. They're going to call me tomorrow after lunch and let me know what's going on.
So, after reading all that....doesn't it seem like she just doesn't understand insurance? Like she willfully misinterprets it or something?