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| *Loan,banking and credit>>>medical insurance |
Insurance/medical billing question? |
A patient calls a doctor and provides correct insurance information, the office says "yes we take that", you provide your insurance card when you arrive, they make a copy, you have your appointment, you leave. Some time later you get a bill for hundreds of dollars from the doctor. "we don't take your insurance, you have to pay" or "we take Blue Cross but not the Blue Cross you have". Can they force you to pay? Are there any regulations about this? It happened to me (I tried to fight it but got nowhere and I paid to protect my credit), my sister (she did not pay and the doctor dropped the issue) and my friend (she paid). All different doctors. It's not fair that the patient should have to pay in a situation like this. Technically, it's the patient's duty to confirm that the provider is contracted with the insurer prior to accessing service. This can be done by either calling the insurer or going to the insurer's web site (all insurers are required to keep their web provider lists up-to-date). (I do not recommend you use the printed provider list, since it's out of date almost as soon as it's created.) On the other hand, the provider's office had the responsiblity to tell you when you gave them your card that they don't have a provider contract with your insurer. That way, you could have made an informed decision whether or not you would access care there. So in reality, both parties (you and the doctor's office) were wrong. You could speak with the doctor and discuss this, but you might not get too far. The most you should probably hope for is a reduction in the bill. If you want to know whether there are any insurance statutes or regulations regarding this issue, call the insurance commissioner's office in the state where the BCBS franchisee is located. (For example, if you have BCBS of CA because your employer is based there, but you live/work in FL, you should call the CA commissioner's office.) I'm sorry I couldn't give you advice that's more encouraging. Source(s): 17+ years insurance industry experience, including 10 years insurance law somewhere on the information you filled out before you saw the doctor you agreed to be responsible for paying the bill, whether the insurance company pays or not. Now in your case you could have called the doctor's office explained that you would never have used them if you had known they did not take your insurance and that you think you were mislead in the process. You could also have threatened to report them to the better business bureau etc. Probably they would have drastically lowered the bill or dropped it all together. Yes, they can force you to pay. The doctor can't be held to "yes we take that", ESPECIALLY over the phone. You HAVE to call the number on the back of your card, to see which providers are CURRENTLY with the plan. AND, it's subject to change without notice!! agent, 21+ years this is something that you and the doc would have to address. Unfortuntally. I work for an insurance company and I hear this all the time. it sucks and I know how you feel There isn't anything the insurance company can do for you. As they stated they participate with you and accepted you as a patient, then you need to talk with them! Its a hard rock and a soft spot! Good luck! |
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