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Help with Insurance / Doctor's office claim!

O

orion23

Platinum Member
Wife goes to the Doctor for a foot problem and makes an appointment with a particular Dr.

She says the office said they participated with our Cigna insurance. She goes to the office and signs all respective paperwork

Dr. sees her and even gives her some type of foot support ($450)

Cigna denies the claim because the Dr. is not in the network and now I have a bill for $1200...

In the past I have had Dr's almost deny me service when they don't participate with Cigna and they really stress the situation.

There is no way that my wife willingly accepted to see this damn Dr. if she had knows the implications...

What can be done @ this point?

I would consider taking the Dr. to court, even if it is just to waste his time...

Edit 1: Called the Dr's office and right away the offered me a much lower price because of the situation...These damn thieves know what they are doing.
Edit 2: I am going to trash this Dr's name as much as I can!
Thanks!

 
Most likely some of the paperwork she signed included a waiver statement that it is the insured's responsibility to verify coverage with their insurer. Pretty much every MD office uses something like that to eliminate the liability of clueless receptionists. In that case, you're boned. Best course of action would be to speak with the Office Manager in person and try to work out a more reasonable rate.
 
Dispute the claim with Cigna. Write a letter stating the situation. Just keep pushing back. At the very least you can negotiate the bill to a reasonible amount. Most insurance Co's don't want to end up fighting you in collection; they'd rather have some form of payment because it costs them more to fight you on it. Just keep at it and don't roll over.
 
Originally posted by: LemonHead
Dispute the claim with Cigna. Write a letter stating the situation. Just keep pushing back. At the very least you can negotiate the bill to a reasonible amount. Most insurance Co's don't want to end up fighting you in collection; they'd rather have some form of payment because it costs them more to fight you on it. Just keep at it and don't roll over.
Click to expand...

Cigna doesn't care whether the doctor's bill gets paid or not - it's the doctor that will be sending this to collection, not the insurance company.


Originally posted by: sactoking
Most likely some of the paperwork she signed included a waiver statement that it is the insured's responsibility to verify coverage with their insurer. Pretty much every MD office uses something like that to eliminate the liability of clueless receptionists. In that case, you're boned. Best course of action would be to speak with the Office Manager in person and try to work out a more reasonable rate.
Click to expand...

This.
 
I'm on a PPO and can go to in-network or out-of-network doctors. I've learned that I have to ask the doctors if they'll accept the insurance but I also have to verify with the insurance company which are in or out of the network. Interestingly, most end up being in-network, I just have call (the insurance company) because the online database isn't always accurate.
 
A lot of doctor's participate in a lot of plans but all that means is that the office will file the paperwork for you. They need to be a provider for your plan to be in your network and have you not pay any additional above the negotiated price. You have to ask the question correctly - and I don't believe for a minute that they don't know that and just answer the question in the way that is best for them. I learned this the hard way and now always ask if they are a provider for Cigna or Tricare or whatever.
 
What it's worth. A lot of health plans don't cover feet supports. If your doctor's office is willing to accept a lower amount, sounds like you got lucky. (even if it don't seem that way.)
 
Originally posted by: compman25
It's not the doctors job to make sure you're insured and covered, it's your responsibility.
Click to expand...

I've tried going to many doctor's offices who have simply said, no can do Sir, we don't work with Cigna...

This time, she was told the Dr. was part of the plan. Sure, she should have called Cigna in advance, but it was not a major procedure or anything like that....
 
Originally posted by: orion23
Originally posted by: compman25
It's not the doctors job to make sure you're insured and covered, it's your responsibility.
Click to expand...

I've tried going to many doctor's offices who have simply said, no can do Sir, we don't work with Cigna...

This time, she was told the Dr. was part of the plan. Sure, she should have called Cigna in advance, but it was not a major procedure or anything like that....
Click to expand...

And now you're paying for it. The doctor can say whatever he wants, he's not the one paying your bill.
 
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