Monday, May 23, 2011

What should one do, when a medical provider charges above health insurance allowance?

Dissatisfied with UnitedHealth's allowance, a radiologist is charging me $188 above copay. UnitedHealth has protested these charges, still he keeps billing me.
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Does the radiologist have a signed contract with United Healthcare? If not, then there isn't much you can do about it. A non-contracted doctor does not have to accept the insurance allowed amount, and you can be billed the difference. If the radiologist does have a signed contract with United Healthcare *and* your Explanation of Benefits says that you are not liable for the $188, then I wouldn't pay it. Make sure to save the EOB, so that you have some proof for dispute if the radiologist attempts to send you to collections.
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