[roni_mf]

I went to visit a dermatologist for regular acne & nails problem. The dermatologist office was in a hospital. She is listed as specialist and I know for sure my insurance co-pay for specialist is $25. A month later received bill from hospital for $196. Insurance claim that there is a deductible of $250 for outpatient hospital bill. Therefore I'm responsible for the whole amount of $196.

Btw I live in Washington state. Does anyone know how should I dispute this bill? Has been calling doctor office who claim they submit a claim billing code. Appreciate any input.

[LearningAsIGo]

Her office may be located within the hospital grounds, but her billing should not be submitted through the hospital. I'll bet the insurance company sped through the claim, noted the address, and charged it as a hospital visit. The other possibility is that she is not considered a provider under your insurance. Is she listed as a current provider as of the date you had the appointment? If not, there might not be a way for you to fight the bill—it's up to the consumer to validate the provider status.

If you are sure this physician is covered under your plan, contact your insurance company with the dispute. Explain the physical proximity of the office to the hospital and go from there. Also, to the insurance industry, honey works better than vinegar. Try to be polite—the people who take calls get a lot of “angry” people so they tend to have their guard up when they answer calls for dispute. ;)
Good luck

[roni_mf]

Thank you for your input.
I did confirm that the doctor is one of the provider prior to seeing the doctor.

The insurance claim that I did go to the hospital, check in as hospital patient since the doctor office is in the hospital. They would consider it as regular doctor office if the doctor send the bill with other address then the hospital.

I also try to dispute with insurance and try to explain that the doctor office is in a hospital but they won't do anything.

Not sure what to do anymore but thank you for your input.

[LearningAsIGo]

Keep trying.

Insurance companies are in the business of charging the patient and denying claims. They won't make it easy on you, that's for sure!

Contact the doctor's office to "pester" them into helping you. Ethically, they should be helping you, but it helps if the insurance company is hearing the dispute from multiple sources.

Again, good luck!