Is this dr shady? Why didn’t he file with my health insurance?
I asked for a referral to a specialist, not one in particular. I received the referral in the mail through my insurance so I made an appointment. I’m assuming he was in-network since they were assigned to me, I didn’t pick.
I have Tricare Prime and have $0 copay. This provider charged me $40. I asked if my insurance covered it and they said no. I paid and had a terrible experience. I quietly walked out and called my insurance company after him saying nothing is wrong with me and he denied me of X-rays multiple times, saying my insurance would not cover it and it would be really expensive for me. My insurance said they most certainly would cover it and didn’t know why they charged me $40 but I should be reimbursed my my insurance. I filed a grievance with my insurance and state board of licensing for the way he tried to intimidate me out of other tests. Once he realized I was also a veteran, he accused me of trying to get VA disability and after that is when he became unhelpful and told me there was nothing wrong with me. My insurance said he will be reimbursing me.
I saw a different provider and I actually do have a fracture that they discovered on X-rays (that my insurance covered). And I still haven’t received my refund from the first provider. Nor have I seen them file anything with my insurance….
My question is, why didn’t he file anything and why did he charge me?? Is there something shady going on? In his review someone accused him of fraudulently forging docs so he doesn’t have to pay the insurance fee. Can someone explain this to me?