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Medical Bill Discrepancy please help

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I have illinicare insurance- a medicaid plan and I was seeing a local chiropractor for about 3 years in this time I never once received a bill or receipt or anything. I just sign in on a piece of paper when I got there and that was it. I was going on average three times a week because it was paid for by my insurance. Recently I made comment to my dad that he could go there because he has the same insurance and my dads gf said she thought other wise that they only accepted my insurance until age 18. At this point I was almost 20. I texted the chiropractor that owns the office and she confirmed what my dads gf had said. I replied and asked her how that was possible If i had been going to her for over a year since I had turned 18. she told me she would have to look into it. I never heard back then all of a sudden she tells me I do in fact have a bill about a month went by where she was supposedly "making adjustments". I asked her why I was never notified or sent a bill and she said it was because my insurance takes forever to submit payment so they were waiting. I then received a $ two thousand some dollar in the mail. She "adjusted it down" to$450 I talked to another chiropractor I know who told me to call my insurance. I did and my insurance has no record of them ever submitting a bill to her, I also never received a insurance denial for any of the visits or received a bill prior to the $450 one. I called the office and requested EOB's for all the claims they submitted. The office was very rude. I ended up calling again and was told they would look into it and never received a call back. I then got another bill in the mall with a "this bill is due now! sticker". I emailed the owner again and told her I had called and wasn't going further with the bill until I was given the forms I requested. Never heard anything back. Today I got a third bill in the mail with a sticker that says"your insurance states your responsible for this bill payment is due immediately!". The bill charges me 50$ for every visit without my insurance yet the office offers an out of insurance program for cash patients and only charges 15$. What do I do here? If I knew my insurance wasn't paying I wouldn't have continued going because I cant afford it. Another thing to is that they claim "Apex insurance" was paying before, yet ive never had Apex insurance and have no idea who they are. Thanks

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We are saying it is not illegal. It is the patient's responsibility to verify a particular service is covered by the plan and the provider in the network. EOB's come from the insurer and are sent to the participant, not the provider. Asking the provider for them is pointless.

 

If your plan covers chiropractic, you can submit the bill to the carrier directly. Check with your plan for claim forms and procedures.

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It isn't illegal. Providers rarely, if ever, know what is covered or not covered under a specific plan. The provider is also very rarely the one who directly sends the bills out to the carriers or tracks payments. Most either have office staff who handle this or they outsource the function.

 

It is also not unusual for certain services to only be covered for minors.

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Among the paperwork signed when you go to a doctors office, is an authorization for them to bill your insurance. It notes that they are billing your insurance as a convenience to you, but that you are ultimately responsible for the bill, if the insurance does not pay.

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