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A question for 1171? - Bummer Knees - 05-12-2011

I have a question for you.

I saw my knee surgeon last March on the knee replacement. This was an approved work comp visit. I was only able to see the doctor because the wc case manager approved the appointment prior to the doctor appointment.

Today I received a bill from the doctor's office billing me for the balance for this appointment. Medicare and Blue Cross & Blue Shild were billed for this appointment and both paid their share.

I have already settled my case with a setaside if approved by CMS, if the seaside is not approved I will then have open medical. (This is how it is detailed in the settlement papers)

My question, what do I do about this bill if the office refused to correct this, isn't this fraud to bill medicare & personal insurance a work comp approved injury.

I've had a history with this doctor's office, they billed me for the TKR, I had a judge's court order granting medical treatment for that one.
It took about a year to get that one taken care of.

Thanks 1171 for your help.


RE: A question for 1171? - 1171 - 05-13-2011

technically i'm not sure it's fraud to bill multiple parties for the same service but it is fraud to accept duplicate payments,
workers comp laws state that payment according to fee schedule by workers comp is to be considered payment in full. they can't go after the worker for additional amounts or "balance due" amounts.


RE: A question for 1171? - Bummer Knees - 05-13-2011

Thanks 1171