Doctors & Co-Pay

I have a troubling issue that relates to both medical compensation and insurance, and I am not certain which authority is the relevant one to contact. Furthermore, if I make a complaint will anything be done to rectify the problem and ensure that it is not allowed to happen anymore??

More and more often I have discovered that the little plastic insurance card that I carry has little or no effect at the cash register of a growing number of medical and dental offices on island. They are simply refusing to bill my insurance company and accept my 20% co-pay. I am being told that I must pay the bill IN FULL and then it is my responsibility to chase the insurance company for reimbursement.

The allegation is, insurance companies do not pay the providers on time, often making them wait for payments as long as 2-3 months before being compensated for the patient's visit. I don't blame the medical providers for not accepting this but am offended that they must punish the patient by demanding total payment for services that ARE covered by insurance in the first place!

To add insult to injury, I have also discovered another disturbing trend (motive) carried out by local service providers in the medical field. Many are overcharging for their services, knowing full well that the insurance company will not pay their inflated fees. They are taking advantage of the patient's ignorance; having us pay these outrageous charges under the assumption that, at the end of the day, we will be reimbursed by our insurance companies. It is only after we regain our senses that we realize we have been scammed and the providers have pocketed a small profit. At our expense! Has anyone noticed the outrageous health insurance premiums of late? Then we must cover the excess charges that insurers CHOOSE not to pay? I am beginning to wonder if there is something shady happening between these two!

Is there no communication between service providers and insurance companies? Wouldn't you think that insurers would post the list of services and amounts that they cover?

The government has mandated that employees MUST be provided with health insurance. Therefore, the burning question is: WHY is the Government not inspecting these health providers and insurance companies or enforcing that they accept our insurance in the first place?

It is apparent that the consumers are being hit twice, not only with high insurance premiums, but we are also left to pick up a hefty medical bill each time we visit a doctor.

So rather than complain about the problem I thought I would try to come up with some solutions!

What I would like to see happen is one or two things;

a) There should be a rate sheet posted online, or at each medical provider's office, advising the consumer of what charges would be covered by insurance and at which amount the insurance companies cap off each service.

b) It should be mandatory for each medical provider to accept our insurance and NOT bill us simply because they are not being paid in a timely manner. Assuming that the insurance companies are legitimate and locally accepted as upstanding organizations that are fit to operate then there is no question that they will pay for the services on behalf of their clients – i.e. US – you and me! If they don’t accept our cards then they should be penalized and fined. If the insurance company takes an extraordinary amount of time to make payment - months and months - they should in turn also be penalized and fined. I guarantee you that if you or I don't make our premium payments on time they will discontinue insurance coverage to us! The same applies to them!!

As it stands, we the consumers are being taken advantage of by both providers, proving once again the need for a Consumer Protection Board.