Provider mixed me up with another patient and charged me for their deductible
Wondering if someone can help me figure out how to approach getting a refund from a provider.
TLDR: I believe that a mental health provider billed me out of pocket for someone else’s insurance deductible (almost $400) in 2020 and I still haven’t gotten a refund despite doing everything possible to correct an insurance error on my part. They kept sending claims incorrectly which caused a year long escalation process with Empire and finally up to the NY AG health care complaint department who was able to finally resolve the claims issues but I still haven’t gotten my money back.
I started going to a mental health professional (New York) in 2019 that was in-network under my parent’s health insurance plan (Empire BCBS). These were weekly appointments. In Jan 2020, my parent’s insurance provider changed our Member ID numbers and I wasn’t aware of the change until around March 2020 when the billing office called me to let me know. I got the updated Member ID numbers from my apartments and sent to the billing office the same day and they said they said they would resubmit the claims for Jan – March 2020.
In April 2020, I turned 26 so I had to leave my parents insurance and was able to get insurance on my own (new insurance also via Empire BCBS). I sent the new insurance information to the billing office (sent photos of the new card through their secure form) as soon as I had it and spent time on the phone with the billing department and Empire to help correct the mistake. Mid April – I was charged (card on file) almost $400 (the charges in question) and I emailed to see what the charge was for and if I could get an itemized invoice of the charges but they said they would provide an invoice once the claims were paid. I kept in contact with the billing department via email consistently and spent dozens of hours on the phone with Empire trying to resolve.
July 2020 – I was charged another $500 to my card despite having a phone conversation with billing a few days before to clarify if any additional copays were owed. They refunded me thankfully but I informed them that I would no longer be using their services as a patient since this was more stressful than it was worth.
In August 2020 – had a phone call with billing to check in on the status of these issues and I have in writing from them that my copays for the claims that needed to be resubmitted (Jan-March 2020) should be $0. In an email thread, the billing representative at the therapists office said that I started with them as a patient in 2017 with Cigna insurance. I replied back to correct them immediately assuming that they might’ve confused me with someone else as I have never had Cigna insurance and they ignored my emails for weeks. Getting a response from the billing department was a consistent problem, they would ignore my emails and I frequently had to schedule a call to get an answer. There’s no direct line to call them either so Empire would have difficulty getting in contact to address and issues that came up.
Come December 2020 – this still had not been resolved and I was escalating this up the chain at Empire. The claims that needed to be resubmitted from Jan-March 2020 were sent over and over again incorrectly, with the wrong member id number, wrong insured name and were getting denied. After asking for months, they finally produced an invoice/receipt that outlined what I was charged for and it again had incorrect information regarding my copays (Cigna insurance – $93 deductible) . The numbers on the invoice also didn’t match up with what they were submitting to Empire in claims. I spoke to billing over the phone and the representative alluded to the fact that there was another patient that has the same first name as me with Cigna insurance.
In November 2021 – I finally submitted a complaint to the NY Attorney General Health Care Bureau as both billing and Empire were giving me the run around since the claims were now being denied due to timely filling. I sent the past years email communication to the representative along with all the context and they were able to escalate this to the top at Empire (grievances I believe) to get the claims paid but the provider still has not refunded me.
Is there any recourse I can take? I’m insanely frustrated with how this panned out especially being that my family and I were dealing with the deaths of 2 family members through the pandemic. I know that it was my responsibility to keep my insurance information up to date but I corrected the issue asap. Are there any legal consequences if a provider mixes up patient information accidentally?
