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Valley medical provider says to pay up even when nothing is owed

Posted at 5:00 AM, Aug 24, 2021

PHOENIX — It's a common practice for medical providers to require payments to be made upfront and before services are given, but what can you do if you're still asked to pay, and you know your insurance will cover the bill?

"It's definitely a thing to have to deal with this," said Samantha.

After losing her leg in a crash and surviving a horse accident, she says she has needed countless x-rays and scans with SimonMed Imaging. However, she says some things need to change with the imaging center because every time she schedules an appointment, they say she owes a $300 co-pay.

"They tell you, 'oh, if you don't want to come, oh, if you don't want to pay, we'll cancel your appointment,'" said Samantha.

She says she's verified her benefits countless times, and she knows she doesn't owe anything out of pocket for imaging, so why do they insist she does?

"They know they have a broken system. But they're not doing anything about it," said Samantha. "Everybody is paying them because they are bullies."

She says she fought to get back other co-pays but doesn't want the hassle.

We reached out to SimonMed about their payment policies, how they verify insurance coverage and why they insist on this co-pay, but they did not respond by airtime.

So, what can you do if you are in a similar situation?

Our insurance expert Michael Malasnik, an independent insurance broker, says to ask upfront when you make an appointment if a payment will be required upfront.

He says at that point, call your insurance company to verify it's allowed in their contract. If not, ask your insurance company to educate the provider or find a more agreeable provider.

Another option, filing a grievance with your insurance company with the provider so they can investigate.

Samantha says she's resorted to having her insurance company on the phone with her as she shows up for her appointment, but it doesn't always go as planned.

"They don't want to touch my phone [because of] COVID. They don't want to talk on speaker - privacy. They got all the excuses why they want your $300 and why they don't want to listen to anybody else," said Samantha.