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pandera p | Insurance company didn't cover doctor visit... now what? |
The first time I used my insurance, I had to select a doctor so I went to the website listed on the card and picked a one. I called the number listed on the website and spoke to someone at the doc's office. I asked her if they took my insurance since I know sometimes those websites can be out of date and she said yes. A month later, I got a bill for "out of network" service. My HR person made some calls and found out that the specific doc in that group doesn't actually take my insurance but that the other docs do. Either way, this wasn't my fault. The insurance co's website was wrong and the receptionist was wrong, so how do I go about disputing this bill? |
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sarah314
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Here's my question:
Did the website specifically state the name *of the doctor you saw*? Or did it list a bunch of doctors in that office, but you didn't necessarily see that specific doctor's name?
If you are absolutely certain that the specific doctor's name you saw was on the website, I'd try to appeal for an in-network payment. You'd have a better shot if you actually had the printed page that showed it. However, it is possible that you could still appeal to have a one-time visit paid as in-network. Just be very specific that you saw the doctor's name on their website at the time you scheduled the appointment. (They can research their system updates and tell whether what you say is correct or not.)
The insurance company may honor a one time in-network visit for this doctor. However, they'll likely warn you that any future visits you schedule will still be out-of-network since you are now aware of his status.
(I used to work for the largest insurance company in my state...that company was *very* strict about in-network/out-of-network status of doctors. Hardly ever made exceptions. But what I described above about a one-time office visit being changed to in-network is what they would have done...if their own website was the one that contained the error.)
Now, if you aren't 100% certain that the doctor you saw was actually listed on the website by his own name (not just the name of the group and/or the other doctors in the group), then I wouldn't be too optimistic about an appeal working. It doesn't matter what the receptionist told you...the insurance company considers it your responsibility to verify directly with them whether or not your doctors are in-network.
(Which is why they should honor a one-time reversal on that office visit, if they had incorrect information published.)
Anyhow...that's the approach I'd take if i were you. (Also, I'd keep the general tone of your letter pleasant or at least neutral...it always amazes me that people fire off angry and/or rude letters of appeal. Don't they realize that you catch more flies with honey than with vinegar? lol.) |
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bud68
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You are stuck. This happened to me when I made the mistake of assuming that all doctors operating under one "medical group's" organization would take the same insurance and took the verbal word of an ignorance medical receptionist. WRONG! You have to verify it for EACH specific doctor by name. |
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Custo
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Well, if the doctor's office confirmed the doc you saw took your insurance... That doesn't mean he's ON your insurance. It just means they ACCEPT it.
There are plenty of reasons a doctor could be listed on the insurance company's website a month ago, and not today. Most aren't all that out of date... but, whatever.
Call your insurance. Ask for a supervisor. They can help. If all else fails, send them something in writing, (an appeal) asking them to pay it in-network. just state the events, in the order they happened, and that you're appealing their decision to process your claim out of network. They'll respond in a few weeks. Tell the doctor's office to wait... |
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mbrcatz
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You call your insurance company and appeal. Ask them to pay as if they were in network, as it's part of the group. |
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JustMe68_86
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Sorry, I think you are liable for payment for the doctor visit. The doctor performed a service and you are responsible for payment, if your insurance is not paying it.
Doctors have the right (and often do) go in and out of networks. The receptionist is not at fault, as some doctors in that office are in that network. Insurance companies do not update their website's every minute of every hour of ever day with current info. Usually once/week. So just because the website showed the doctor in network, it doesnt mean that the day before he didnt stop.
You can try obtaining a lawyer and see what he says, if you really feel you are not responsible for payment. An attorney would be more appropriate to answer this type of question.
Good luck |
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Lori S
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Your only real defense is that the doctor was listed on the company's website. Is he still listed? If so, print it and send a letter to the insurance company explaining everything you have said and ask them to reconsider it. I don't hold out a lot of hope, but you can try. In the meantime, make arrangements to make payments on the bill so it doesn't hurt your credit later. |
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yukrchick
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You can't dispute it. You saw the doctor, you owe it.
Next time call the insurance company or if you have to work off of their website, print out the page that shows the doc you're choosing is participating. That still doesn't guarantee that by the time your appt comes around that doc will still be participating. They can stop when ever they choose. |
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Jeremy H
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Hire James Sokolov |
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iip
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If its necessary press charges with the police. |
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