Can a healthcare provider charge more than the insurance-negotiated rate?

42/female. 33566 zip code. Income 60K.

I got a set of hearing aids from a clinic several months back. They didn't work out for me, and I returned them for a full refund within the trial period.

My insurance covered them 100% because I hit my maximum out of pocket deductible for the year due to a surgery I had in January.

Before the refund was completely processed, I found a different audiologist and decided to get hearing aids from them. I explained that my insurance would cover the cost, but that there was a refund pending for the previous pair. They suggested I put the hearing aids on a credit card and then once the refund was processed they could refund my card and file the claim with my insurance.

The refund has been processed and I've asked them 3 times about the status of the claim and the audiologist's office has lied to me. They've told me each time that a claim was filed but today I demanded the number for the corporate location and was informed that they have not even submitted a claim.

That's not the worst part! The audiologist office also told me today that if my insurance only covers say $5K because of contract negotiated prices, they will not refund the additional $2.2K (I paid a total of $7,200). I was absolutely NOT informed of this when I agreed to put the hearing aids on my credit card.

Can they even do that? Is it legal for them to force me to pay the difference between my insurance negotiated price? I'm hoping he's just mistaken and didn't understand my question, but right now I'm feeling completely lied to and I am trying to figure out what steps I need to take to get this claim filed and protect myself.

See also  Insurance says my lack of care caused my dental implant to fail. Can I fight that?

Should I reach out to my insurance company directly?

submitted by /u/tickets4gold
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