How does a doctor’s office know when my deductible has been met?

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Mar

24

2010

I already met my deductible for the year yet the billing person at my doctor’s office made me pay an additional amount to pay off my deductible. How does she know how much I owe and how can I prove to her that I already paid my deductible. I want a refund!

In: Deductible Asked By: Dale [2

]

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2 Answers

Answer #1

They are able to call your health insurance company and check. Keep in mind however, if you have gone to other doctors who have NOT billed your insurance company yet, the amount of money towards your deductible will NOT be accurate. Pay attention to the statements you receive from your insurance company (Explanation of Benefits (EOB) ) and if the amount this says you owe is different/less than the amount you paid, CALL your doctor and ask for a refund. They will NOT automatically do so. If you need help resolving an issue, email me and I will direct you.

Michelle Jorgensen, Owner
Medical Claims Consulting
Ph: 512-439-9679 Fax: 888.736.9656
Website: http://www.medicalclaimsconsultant.com
A voice that speaks for you in the health insurance system

Answered By: MedicalClaimsConsulting [11

]

Answer #2

Physicians in network have online access to your information. That how they know how much is the balance of your deductible. The problem in your case probably based on outdated information. Your insurance can only update your deducible when they receive claims. If you had seen another doctor, and therefore you met the deductible, but they didn’t send in the bill, then your information isn’t updated until they do so.
Your solution is to wait until the bills go in and check your Explanation of Benefits (EOB). Once all recent bills are processed your EOB will show your responsibility. If that is less than what you paid to your doctor you can show them your EOB and ask for a refund.

Answered By: Med Bills Assist [10

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