I'm not sure if anyone knows about this; but I hope someone has some knowledge :)
I have a supplemental health options (SHOP) policy through Allstate Workplace, that pays for hospitalization, surgery etc.
It's been over 3 months since surgery & I filed a claim 3 days after surgery. They're dragging their feet and I get different answers about the status each time I call. I've called, emailed and faxed 50 times (all noted with dates/times/names) so far.
I found out last week, Allstate sent my EP's office a check for "surgery benefits paid in error" a month after my surgery ($1,200).
The EP's office refuses to refund the difference of my bill $375 and the check $1,200 to me. Basically they're holding $820 and will only refund the entire $1,200 back to Allstate; "in a month or two". Allstate won't accept it; which means if they send it back to Allstate, my claim won't be approved and will be denied and go into the appeal process, which could take up to a year.
Allstate says I have to get the refund from my EP because they took the check knowing it was not theirs and cashed it and put it in their account, they've had it for 2 months and didn't send me an invoice noting the payment.
The EP's office says there's a FL state law that they have to send it back to Allstate, but couldn't quote the law when I questioned them which one specifically.
I got so frustrated over it all my BP & HR have stayed in the dangerous zone and feel like I'm going to have a heart attack. I finally filed a complaint with the FL Department of Insurance regulation & Consumer Services, hoping someone can help me.
Now, over my EP's billing department fiasco I don't feel comfortable going back - he said I will have to have surgery again in 3 mths - and I may have to go through this mess again with their office.
I don't know what else to do and if anyone knows, I would appreciate any info or help?
This site complies with the HONcode standard for trustworthy health information.
The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease; or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. Med Help International, Inc. is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. Never disregard the medical advice of your physician or health professional, or delay in seeking such advice, because of something you read on this Site. We offer this Site AS IS and without any warranties. By using this Site you agree to the following Terms and Conditions. If you think you may have a medical emergency, call your physician or 911 immediately.