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Provider/Carrier Contracts


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I would like to share something with everyone. While trying to clear up some collections I am not liable for resulted in my finding that the contracts signed by Medical Providers and Insurance carriers have certain guidelines that must be followed. For example, your insurance denied payment saying " there may be other insurance which might be primary", "diagnosis not an emergency", or some other denial requesting more information from provider, provider is bound by contract to aquire this information and rebill. If they fail to do this within the timeframe allowed, they cannot bill you. It is their liability and must be written off. Also, as part of their contract, they agree to never bill the patient more than the allowable cost share. Be sure to check with your insurance carrier as to what is involved in what I said. This happened to us. A provider sent bills to collection instead of aquiring the requested information. He has since been sent letters from our insurance as to his actions. The items still remain on our files. He thinks he is the ONE. LOL! I am one of those who hope HMO's disappear as they are scumbags in how they treat us as consumers. I shared this as I never knew about it until I pursued the Collections showing on our files. Hope this can help someone.

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