Insurance Company Won’t Pay Clinic

WSVN — Whether you are a patient that can’t get your insurance to pay for your medical care, or a medical provider who can’t get a patient’s insurance company to pay you, it can be frustrating. Is it hopeless? No, which is why one clinic operator called Help Me Howard with Patrick Fraser.

Greta had a goal, open a chiropractic clinic…

Greta Paterson, Max Medical Care: “Everything having to do with massage therapy, helping people after an accident as well.”

Five therapists, two doctors and a specialist for facials, Max Medical Care was busy, and Greta was happy…

Greta Paterson: “It’s amazing when you can help people. It’s not work, it’s passion.”

A passion for patients… and then there are their insurance companies.

Greta Paterson: “Well, that’s a different story.”

The work done here is covered by insurance, and six insurance companies paid for their patients care — one has not.

Greta Paterson: “It’s been nine months, and I haven’t received one single check from United Health Care.”

Unfortunately for Greta, 70 percent of the patients seen at Max Medical Care have United Health Care Insurance.

Before paying, all the insurance companies wanted proof both doctors and the clinic were licensed. Every insurance company verified the licenses with a few days, but no verification from United Health Care, even though Greta called day after day…

Greta Paterson: “I have been actually told not to call every day, that I am wasting my time. Every time you call, they say it’s going to be five to 15 business days until we give you an answer.”

But no answers as the amount owed Greta grew and grew as she treated dozens and dozens of patients month after month.

Greta Paterson: “Let’s say it’s $180,000 out there, no I am not going to get all of that, I’ll get 30 percent… which to me, as you can see, this is a small place. That’s a lot of money.”

And without that money coming in, Greta was forced to cut her staff…

Greta Paterson: “Honestly after nine months, I think nobody cares. What is it? You are trying to get me out of business? Is it personal?”

Well Howard, does an insurance company have all the time in the world to pay a claim to a medical provider?

Howard Finkelstein: “The time frame allowed to pay varies. Usually, it’s 20 days to pay or deny the claim. This went on for nine months and because of that, the insurance company can be fined by the State of Florida for failure to pay.”

I contacted United Health Care’s corporate headquarters, and that worked. A spokesperson told me that a couple of things raised red flags.

He didn’t tell me what they were, but it’s well known that insurance companies are cautious about paying in South Florida because of so much fraud.

Greta of course was perfectly legitimate, and after our calls, the payments from United Health Care started coming in…

Howard Finkelstein: “If you can’t get paid by an insurance company, file a complaint with the State of Florida or hire a lawyer and sue them, because by law, when you win, they have to pay your legal fees.”

Greta Paterson: “We had Patrick, we had you guys, and I will be forever and ever grateful because all of that has been resolved.”

With the checks rolled in, the stress of not being paid is over for Greta and she can now focus on her patients’ stress…

Greta Paterson: “A lot of people don’t realize, but most of the issues people have are caused by stress. And you come see us, you can get a massage, chiropractic services, physical therapy. We help you with the headaches.”

Glad we could help Greta get rid of those insurance company headaches. After we stepped in, she got nearly $40,000, so she is a happy lady. And remember, whether you are a customer of an insurance company, a provider of medical services or if you are having problems with Medicare, don’t fight them alone. There are state and federal agencies to help you. The links to file a complaint with them are below.

Stress wrecking your life? Want to ensure it’s resolved? Let us put on a clinic. We don’t do massages, but solving your problem is great therapy. With this Help Me Howard, I’m Patrick Fraser, 7News.

FOR MORE INFORMATION:

Insured or Medical Providers file a complaint with the State of Florida
http://www.myfloridacfo.com/Division/Consumers/needourhelp.htm

To File a Medicare/Medicaid complaint:
https://www.medicare.gov/claims-and-appeals/file-a-complaint/complaint.html

The link to the state insurance guide:  http://www.myfloridacfo.com/Division/Consumers/UnderstandingCoverage/Guides/documents/HealthGuide.pdf

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