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uchiha_30 | Can my doctor refuse to see me because insurance has not paid because the doc has not done the paperwork? |
I had surgery back in June, and two follow up appointments, all which have NOT been paid by my insurance company. I was told multiple times by the insurance company that they are waiting for the DOCTOR to send in the additional information they requested. Bottom line is that insurance won't pay until the doc sends in the paperwork. I had complications from surgery, and the doctor told me I needed to follow up with him again. His office called and said the billing department wants to wait until the claims are paid before they let me have an appointment. My appointment was supposed to be this week. When I called last month to make the appointment, I told them again that the insurance was still waiting for the doctor to send in the paperwork. I have been in touch with the insuracne, and they are still waiting.
Can they not see me because the doctor has not filled out the necessary paperwork to get paid? Because I had complications after surgery that are unresolved; the doctor has said he needs to follow up with me, so how can he refuse to see me now, against his own medical judgement?
Who can I contact for help? Is this legal?
I am in Massachusetts.
Thank you in advance for the help! |
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Insurance Geek-ette
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Yes, the doctor can refuse you for just about any reason. They are not MANDATED to provide services for anyone who wants them. |
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sarah314
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If you are having complications from a surgery performed by that doctor, he would be foolish to refuse you a follow-up appointment. What sane doctor would want to leave himself open to a potential malpractice complaint?
It may be technically legal, but it certainly would be an unwise move on the doctor's part! (Again, presuming that you're trying to schedule a follow-up with the same doctor who recently performed the surgery that's giving you trouble.)
I agree with the others that you should speak with the doctor directly. Its entirely possible that he isn't aware that his billing/administrative staff is not allowing you to schedule an appointment. And if the doctor does still refuse to see you, at least you know that it is coming directly from him. (Good information to have, in case you need to take any further action.)
Good luck. |
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Lori S
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Basically, your hands are tied. You could contact the doctor's office to try to get them to do what they need to, to get the claim paid. But if he refuses to see you-which is his prerogative, you still need to be seen. Try another doctor. |
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1-2informationalways
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PLEASE, read this: First of all call and ask to talk to doctor on phone. I have witnessed so much go on in doctors' office behind their backs!!! Though doctor is not the one handling the insurance part (I hope) of his office, he is the one person rightly so telling you you need FOLLOW UP. If for some reason they refuse to put him on the phone, ask for his voice mail. Whether by phone, by voice mail or in person, you must tell him what is going on. Try to be as calm as possible when telling him whole story, which I'm sure you feel you've retold over and over to so many!!!
Don't leave out fact that INSURANCE CO. has repeatedly requested those papers. On the contrary, make emphasis on it.
If he were to send you back to office personnel, calmly again explain WHOLE SITUATION and fact that you are complying with doctors order for follow up. If they say they've sent paperwork or fxed it to them, ask to have it done again, in case there was an error. Tell them (to give them benefit of the doubt) that you know these things can happen and that you are sure they did send them but must have gotten lost or misplaced somehow.
It wouldn't hurt either that you go over all insurance card information and even any other information you may think has been copied wrong, etc.
Depending on what kind of surgery you had_it could have been a simple office procedure, or something of critical importance_you must try for this same doctor to see you. Besides, wouldn't go to another doctor incur in same or similar insurance payment problem if problem is with the insurance co. and/or card, information, etc.?
Something which would make it all easier would be to ask INSURANCE CO itself for a written request for all paperwork needed to be submitted by doc's office. If it can be faxed or sent to you, take it personally to doc office. And don't forget to ask for copies of anything and everything you deemed important! |
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PapaJR
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The doctors office can decide who they do and do not see for reasons including unpaid bills. However, if they are an in network provider they have a contract with the insurance company to follow certain procedures.
Try to find out from your insurance company what exactly they are needing. They may be looking for medical records/notes, etc. Also, see if someone from the insurance company can call the providers office and tell them what info is needed.
If that doesn't work then I would try to get the needed information from the providers office and send it in to your insurance company. Sometimes what happens is the providers billing department does not want to take the time to see what is needed or contact the insurance company, but their laziness is no excuse.
You may need to get a little pushy in order to have one party contact the other (dr's office and insurance company) to get it resolved. |
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Anne R
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Any doctor can refuse to treat you but your doctor may not know that you are being prevented from making an appointment.
His staff think they are doing a good job by waiting for the insurance payment. I don't think your doctor would agree with them but you need to talk directly to the doctor.
Leave a message with the office staff asking for your doctor to call you. Be sure to leave a time when you know you will be home to take his call and ask when he normally returns his calls. Most doctors return calls at the end of the business day.
When you speak to the doctor, explain that you are being prevented from making an appointment because your insurance company hasn't paid him because his office hasn't sent the necessary paperwork.
It is not that complicated once you get the two "right" people together. The person in his office who is responsible for the patients' medical records (not the billing department) and someone from the insurance department who handles claims (there is a toll-free number on the back of your insurance care for customer service) need to communicate. You can help by calling the doctor's office and ask to speak with the person who handles the paperwork (not the billing or the scheduling) after you have called the insurance company and obtained the name of someone in the claims department of your insurance company.
Also, if your insurance is provided by your employer, your human resources department may have be able to assist you by contacting the insurance company.
I hope you are feeling better soon. |
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