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
  • 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.

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