[DianaVarde]

I had my daughter's eyes examined by an Optometrist and paid out of pocket since I don't have eye coverage. The Optometrist wanted to see her again in a month to see if her eyes improved. When I took her for the appt. the Optometrist referred me to an Ophthalmologist because he said that she may have an eye problem. When I made the appt. with the Ophthalmologist I told them that the Optometrist recommended that I see himl. When I took my daughter for her appt. the Ophthalmologist didn't find anything wrong with her eyes and refused to file with insurance because he said it was a routine exam. My insurance company told me that they would have covered it, but since the doctor refused to file a claim, there was nothing they could do. The Ophthalmologist told me I had to pay $70 for the visit right away or they would charge me $130 if they had to bill me. So there are two problems. One, can the doctor refuse to file insurance and 2. Does he have a right to charge me almost twice as much if I have to be billed.

[smoothy]

Did their office accept your insurance? If they did but refused to make the claim, get the information and code for a routine exam, and file with your insurance for reimbursement. I would also report them to the state liscensing board, and lodge a complaint with the Better Business Bureau.

This assumes your insurance covers the exams. If her eyes were bad or not makes no differnce, You go to find out if they are bad or not. That's like going for an anuual physical but they won't submit it unless you are sick.

You are going to need more specific advice than I have... but having dealt with a medical practice that improperly filed a claim and refused to correct it... and worse made threats, yes real threats in writing, now has a BBB negative report on record against them they were unable to disprove the validity of. Nice when they lose it in writing.

Took a lawsuit threat from a lawyer to get them to do what they are required to do... and an entire large medical practice that no longer reffers ANY patients to that entire medical center.

Sounds like they are not too ethical, and deserving of some bad word of mouth publicity.

[Fr_Chuck]

You are still free to file with your insurance, a doctors office is under no obligation to file for you ( unless their contract with the insurance company requires it) You may get a coded receipt from them and file it with your own insurance.

This was the way a lot of doctors were 30 years ago.
And there is also all sorts of fee levels, if they submitted it to insurance they may have been required to only take 30 or 50 dollars. That would have been the insurance contract price they are obligated to. If it was a medicare or medicaid patient they have set rate they have to accept for them,
And they are free to have a discount for cash paid at time of service and not billed if they want.

Now being able to and it being acceptable, I would report this activity to the insurance company and the state AMA group