Savannah, GA asked in Health Care Law, Legal Malpractice and Medical Malpractice for Georgia

Q: Can a Dr.'s office legally bill under a different tax ID to get more money?

I was referred to a specialist by my primary care dr. The referral was approved by my insurance company and I called to verify before visiting the specialist. On my 3rd visit to the specialist, I was told that I owed them nearly $500 because they are not in network with my insurance company. After weeks going around in circles, I was able to confirm that they are listed under 1 tax ID that is in network with my insurance company. This was the tax ID the referral was submitted for and it was approved. However, they use a different tax ID to submit claims, which is not in my health insurance's network. They refuse to submit under the in network tax ID and they also refuse to admit that they have these 2 separate tax IDs. They claim they only have 1 tax ID and its not in network and we owe them money. I have proven this to be incorrect, but now I am stuck and have no idea what to do. Is this legal?

1 Lawyer Answer
Peter N. Munsing
Peter N. Munsing
PREMIUM
Answered
  • Medical Malpractice Lawyer
  • Wyomissing, PA

A: may be legal but I think you can ask your health insurance if they will offer payment under the other tax ID, then when you have them rejecting a documented offer you can tell them your company offered to pay, they refused to accept, you don't think you owe them in accordance with provider agreeement, and you will contact the health Department at the state level.

Justia Ask a Lawyer is a forum for consumers to get answers to basic legal questions. Any information sent through Justia Ask a Lawyer is not secure and is done so on a non-confidential basis only.

The use of this website to ask questions or receive answers does not create an attorney–client relationship between you and Justia, or between you and any attorney who receives your information or responds to your questions, nor is it intended to create such a relationship. Additionally, no responses on this forum constitute legal advice, which must be tailored to the specific circumstances of each case. You should not act upon information provided in Justia Ask a Lawyer without seeking professional counsel from an attorney admitted or authorized to practice in your jurisdiction. Justia assumes no responsibility to any person who relies on information contained on or received through this site and disclaims all liability in respect to such information.

Justia cannot guarantee that the information on this website (including any legal information provided by an attorney through this service) is accurate, complete, or up-to-date. While we intend to make every attempt to keep the information on this site current, the owners of and contributors to this site make no claims, promises or guarantees about the accuracy, completeness or adequacy of the information contained in or linked to from this site.