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Current medical insurance problem
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Posted by Medical Bills
(64.164.162.20) on July 10, 2003 at 17:22:22:
I have just been sent a $835 bill for physical therapy arising out of knee surgery I had in March. When I first went into the therapist's office, I told them outright that I wasn't sure that I had insurance benefits for PT. They said they'd look into it and get an explanation of benefits. Once they did, they received information that my PT benefit was capped at $750. The insurance rep at my surgeon's office also received the same info.
With that info, I went to see the PT 6 times, always asking them if I was coming close to the $750 max. They said no and after the 6th visit, they told me to stop. It turns out that I didn't have a $750 PT benefit (but that I had a $750 max benefit for all sorts of things, including PT, MRI, x-rays and doctor visits). Because my benefit had been maxed out even before the PT bills, I'm stuck with the balance. And that isn't the only problem, the PT balance is for $835 even though the office knew full well to keep the cost below $750.
Do I have any legit complaints here? Shouldn't the PT office get an accurate explanation of benefits from my insurance co, especially since I told them the plan was ambiguous. If I knew it cost this much, I wouldn't have gone to as many PT appointments as I did (especially since I've had the same knee surgery done years before on my other knee). Any advice???
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