How do we stand up for ourselves as consumers of special needs services?

[Anonymous]

I am trying to understand what kind of rights do consumers of special needs services as ABA have. We've done ABA with Verbal Beginnings. Our last session with them was about half a year ago. Just now I am getting bills from them for the services we received in spring 2021! The charges seem to be inflated to me. It looks like they break work into chunks so that they can charge copay multiple times. They are charging for multiple supervisors during the same day of service at their center which does not seem right. Last week I am getting a different communication from a person at their billing department saying they need me to configure benefits for my son's two insurance companies and that it is a different company that needs to be the primary. Originally, they sent me a note on which company is the primary, billed that insurance and got reimbursed which I can see from the EOB. It looks like now they are about to bill the other insurance company. It is confusing to me as to what they are really trying to do. I certainly do not want to pay my copays twice.

Which resources can I use to understand what my rights in this situation are and what they can and cannot do. How can I contest some of their charges which do not seem correct? Is it legal to start billing for services years later and send multiple thousand dollar bills instead of billing at the time of service?

I would appreciate any advice!

[Anonymous]

Most of your questions depend on your insurance. If your carrier has a deadline for billing, then the provider has to meet that. If not, they can bill years later. If the policies require you to pay two copays to get all of your benefits, then you have to pay twice.

I think the big thing is to know before you start what your obligations will be so that you can make the best decisions you can for your family. And if you have questions regarding billing, your carriers should be able to help. They typically weed out any unauthorized charges and bar balance billing.

[Anonymous]

Anonymous wrote:Most of your questions depend on your insurance. If your carrier has a deadline for billing, then the provider has to meet that. If not, they can bill years later. If the policies require you to pay two copays to get all of your benefits, then you have to pay twice.

I think the big thing is to know before you start what your obligations will be so that you can make the best decisions you can for your family. And if you have questions regarding billing, your carriers should be able to help. They typically weed out any unauthorized charges and bar balance billing.

Thank you for replying! I understand what you are saying but my question is a little different. How to deal with things such as frivolous billing for ABA therapy? For example, in the end of occupational therapy session we pay our copay. It is pretty straight forward. I know which charges to expect. With this ABA provider, we were not ever told how they will be billing. There are individuals on EOB whom I never even heard of. They did not provide any services. The first invoice I got is almost 2 years after we started receiving service. There got to be a regulatory body that oversees billing/financial practices of ABA providers. I am trying to find out what it is.

[Anonymous]

I have had some luck with reaching out to my state or county local representative with things like this. They have staff who research stuff like this for constituents.

[Anonymous]

I once posted a question about getting bills more than 9 months after the fact and people jumped all over me. If you are in MD there is the insurance commissioner's consumer hotline.

[Anonymous]

They’re probably using an outside billing service. Many providers do. Rather than being an ass about their slow billing just help them get paid. I hate insurance, so does your provider. Your insurance provider usually has a time limit for filing claims.

Sometimes the listed provider is incorrect. If you actually got service on that day, then pay the bill. Otherwise reject the incorrect claim through your insurance carrier.

[Anonymous]

Sounds like a billing issue nobody can answer except the company or your insurance provider.

[Anonymous]

Anonymous wrote:They’re probably using an outside billing service. Many providers do. Rather than being an ass about their slow billing just help them get paid. I hate insurance, so does your provider. Your insurance provider usually has a time limit for filing claims.

Sometimes the listed provider is incorrect. If you actually got service on that day, then pay the bill. Otherwise reject the incorrect claim through your insurance carrier.

They are NOT using an outside billing service. It is coming from the company itself.

It can that I worded my post in a way hard to understand. I am NOT asking how not to pay my share. It feels to me that they are not billing appropriately and I am trying to figure out whether there is an agency which can help me get me through the situation or it is a wild wild west with ABA providers and their billing.

[Anonymous]

Anonymous wrote:

Anonymous wrote:They’re probably using an outside billing service. Many providers do. Rather than being an ass about their slow billing just help them get paid. I hate insurance, so does your provider. Your insurance provider usually has a time limit for filing claims.

Sometimes the listed provider is incorrect. If you actually got service on that day, then pay the bill. Otherwise reject the incorrect claim through your insurance carrier.

They are NOT using an outside billing service. It is coming from the company itself.

It can that I worded my post in a way hard to understand. I am NOT asking how not to pay my share. It feels to me that they are not billing appropriately and I am trying to figure out whether there is an agency which can help me get me through the situation or it is a wild wild west with ABA providers and their billing.

The agency to call is your insurance company. It’s their rules regarding billing that the provider has to abide by.

[Anonymous]

But they are billing late, and you are upset and don't want to pay what might be your fair share - you are upset they billed late and haven't even looked into any of it.

Perhaps it's a small office and the billing person has been fighting breast cancer. Or dealing with an elderly parent with dementia. Or a terminally ill child. And maybe just now they are catching up on all the outstanding bills while the compassionate employer has been trying to stay afloat and pay their employees.

Instead of also getting upset with people here, you need to start by contacting Verbal Beginnings, ask for the billing dept., and ask for someone to help you understand the bills.

You can also, pull all of your insurance company EOBs (Explanation of Benefits) and see how much they billed you, how much your insurance paid, and how much you owe.

Also, I would almost guarantee that you signed something prior to starting treatment (probably with all the intake forms), stating that you'd pay the part you were responsible for.

Finally, one last thought. Is it possible you are looking at "statements," which are not actually bills? It's just showing you what was sent to your insurance company, before the insurance company pays their part, and before the provider writes off the amount that is unallowed.