Does it really take 5 months to be reimbursed by a doctor's office?

by Karen
(Mesa, Az, USA)

My Primary Care office did not complete/submit the paperwork needed for a sleep apnea treatment by a dentist in July of 2015. The billing department (?) for the dental office called the day before the appointment to let me know the paperwork had not been received.


Nothing was said about cancelling or rescheduling. I arrived for my appt and was told that I might have to pay because the paperwork had not been received. I chose to pay. $2360 on my credit card.

This situation is endless, but Medicare denied the claim initially because J, from the billing department made many errors on her paperwork. J admitted to the errors and said she was going to refile.

I had no confidence in her so I began making calls to Medicare--numerous calls as I was transferred from one dept to another. Finally, I was told to make copies of the necessary paperwork and mail them and the appeal to Noridian, who handles Medicare appeals.

Weeks go by and J has nothing to report. I have not received any reimbursement from anyone--not the dentist, not Medicare, not Noridian, and not American Continental Insurance (my Plan F insurance co.)

I begin making the calls again and learned that Noridian claims they already wrote the check, that American Cont. Ins. has no knowledge of a claim, that J stated she hadn't received any payment from Noridian, and that J was waiting on a check for $200-some dollars from American Cont. Ins. This was in Oct.

In November I manage to speak to an office manager, not J, who found the check from Noridian and was going to reimburse me for that portion of the $2360. She mailed me a check for $1070. She then stated that when the check came in from American Cont. Ins she would send the remaining amount.

I questioned her about how much the check would be, and she did some subtracting and came up with a figure that would total $2360. Odd. J said they were waiting for a check for $200 some dollars. That check and the $1070 would not add up to $2360.

At any rate, it is December and I am still waiting for the next check. J clearly was incompetent and was "pulled into" the dentist's office from the billing department. I am not incompetent, I kept records of numerous phone calls, spoke to many people at Medicare, Noridian and American Continental Ins, mailed all requested paperwork to Noridian, and kept track of my Medicare statements during these 5 months, and I am at a loss.

I don't think Medicare or American Cont. Ins created the problems--my primary care office and J did. The office manager seemed sincere, but, really, how long is this going to continue?

I did my part. In July I paid the bill in full. I owe them nothing.

They owe me a check, at the very least. They need to do their part.

Response:

Karen,

Thanks for sharing your story. I understand your frustration.

It shouldn't take 5 months to be reimbursed. But unfortunately as you've experienced getting reimbursed from the doctor's (or dentist's) office can take a while depending on how efficient their billing department is.

I think the providers folks could have done a much better job of informing you that you would be responsible for payment when you showed up. Or at least giving you the option of re-scheduling until the paperwork was worked out.

Hope you get it straightened out and paid back soon.

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