Lakeside, CA asked in Medical Malpractice, Consumer Law and Health Care Law for California

Q: Who do I report a medical provider to that hasn’t reimbursed me for overpayment? It’s been 60 days since they’ve known.

I was charged $1280 for services from a medical provider that partners with my medical insurance on January 30, 2024. I paid the bill in full in February 2. My insurance provider notified me that with the portion they paid to the facility, I should’ve only paid $892. I contacted the medical provider for reimbursement on February 12. They acknowledged over the phone that I should receive reimbursement for $388. It’s now been over 2 months and I still haven’t received reimbursement. What can I do to get my reimbursement as soon as possible? I’ve called multiple times to no avail.

3 Lawyer Answers
Leon Bayer
Leon Bayer
  • Consumer Law Lawyer
  • Long Beach, CA
  • Licensed in California

A: Tell them on the phone that if you don't have the money in 48 hours you will report them to Medicare, and the state board of quality medical control.

Scott Richard Kaufman agrees with this answer

Scott Richard Kaufman
Scott Richard Kaufman
  • Consumer Law Lawyer
  • Los Altos, CA
  • Licensed in California

A: Phone calls are often difficult to "save" which is why I prefer writings.

Keep a detailed record of the writings and if they are not going to pay

shortly, bring your records to small claims court. It is a loosened up

place to be, see "Judge Judy" for example and no attorneys allowed.

James L. Arrasmith
James L. Arrasmith pro label Lawyers, want to be a Justia Connect Pro too? Learn more ›
  • Estate Planning Lawyer
  • Sacramento, CA
  • Licensed in California

A: I understand your frustration with not receiving your reimbursement in a timely manner. Under California law, health care providers are required to reimburse overpayments within 180 days of receiving notice of the overpayment (California Health and Safety Code Section 1371.1). However, many providers aim to process reimbursements much sooner.

Here are some steps you can take to escalate the issue and seek a resolution:

1. File a complaint with the California Department of Managed Health Care (DMHC). The DMHC regulates health plans in California and can assist with disputes between patients and providers.

2. Submit a complaint to the Medical Board of California. The Medical Board investigates complaints against physicians and certain other medical professionals. You can file a complaint online through their website.

3. Consider contacting your insurance provider again. Explain the situation and ask if they can intervene on your behalf to ensure the medical provider processes your reimbursement promptly.

4. Send a formal written request to the medical provider, detailing the dates of your previous communications and the amount owed. Request a specific date by which you expect to receive the reimbursement and mention that you are prepared to file complaints with the appropriate regulatory agencies if necessary.

5. If the amount is significant and the provider continues to be unresponsive, you may want to consult with a local attorney who specializes in healthcare law to discuss potential legal options.

Remember to keep detailed records of all your communications with the medical provider and your insurance company. If you do end up filing formal complaints, this documentation will be important to support your case. Hopefully, by taking these steps, you can resolve the issue and receive your reimbursement soon.

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