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Jack | My insurance company refused to pay my bill because I went to see a doctor without appointing a PCP. Any idea? |
I bought HMO medical insurance through my employer. I went to see a doctor without appoiting a PCP. My insurance company refused to pay my bill because of that. I cannot select one now either because I have left for another company and am with another insurance company. Do I have to pay for the medical bill all by myself? I know it is my fault. But it is really expensive and I did have insuance. I did not choose a PCP because I knew I would leave soon but unexpected things do happen. Thank you very much for your suggestions. |
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sarah314
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Honestly, I would not be too optimistic about your chances of getting the HMO to pay the bill. Selecting a PCP is one of the basic, essential requirements of an HMO plan.
Was the doctor a specialist or a doctor who would have been eligible to be your PCP? Was the doctor in your HMO's network?
If the doctor was a specialist and/or out of network, then I'd say you have no chance at all of getting the claim paid.
If the doctor was someone you could have selected as your PCP, then the odds aren't much better (maybe less than 2%). But, you could always try writing a letter of appeal. Let them know that this was the doctor you intended to have serve as your PCP.
Otherwise, work out a payment plan and/or negotiate a discount (if possible) with the doctor and chalk this up as a learning experience. |
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mbrcatz
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Well, if you were still with them, I'd say, select your PCP, and file an appeal in writing. As it is, you can still file the appeal in writing, but I'm not sure you're going to have a big chance winning it.
It's an expensive lesson. But you have to follow the rules. I hope you've chosen a PCP for your current plan, even if you don't plan on using it. |
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bud68
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You are stuck. You knew you needed to have a PCP and didn't use one. |
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MSAD
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If you are no longer with that company - then you are stuck.
HMO's that require a PCP - use the PCP as a gatekeeper. If you want to go to a specialist or have test/procedure done - you have to have your PCP refer you. It's easy - I've never heard of a PCP saying you can't see another dr- but you do have to follow the procedure. Since you did not - they are not required to pay the bill.
If the service was rendered at a hospital or the bill is from a hospital - call up the billing department. Offer to pay them 50.00 per month until the bill is paid in full. As long as you make your monthly payments and don't miss any - they are not going to turn you over to collections. |
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Freedom
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If selecting a PCP was a requirement, then you will have to pay. Do not pay from a statement, wait for the bill from the Doctor. When you receive that call the Doctor's office and negotiate with them. They often charge more when they know an insurance company will cover the negotiated rate. Explain the situation to them and they should at least offer a big discount. If you are a regular patient of this Doctor, that could also be in your favor.
You could also contact your old HR department. If they are good and you left on good terms, they should contact the insurance company. They are usually on a first name basis with the rep and you would be surprised what they could do. They are under no obligation of course, unless you feel the fact that you had to choose a PCP in the first place was not clearly communicated by them. |
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