recourse when doc's office screws up insurance coverage

[OS]

Does one have recourse when you ask the doctors office if they take your insurance, and they say yes, but then you get a large bill from them anyways and you find out that you are probably NOT covered later?
I realize i should check independently, but in some cases that is not always practical or easy to find

.

 

[KLin]

Tell the doctor to take it up with your insurance?

 

[OS]

yeah i am going to, but they make you sign a form that you are financially responsible regardless of actual coverage.
The whole situation is kind of messed up with this stuff because the offices almost always tell me i am covered but then I get a bill later anyways and I have to go argue with them.

It's almost like most doc's offices use those CYA forms as an excuse for their own sloppy knowledge and work over billing.

 

[Crucial]

Isn't it your responsibility to call the insurance company to verify your coverage? Why should the doctors office care if you are or not? They are just processing your claim after you present them with your insurance info. They have no way of knowing what is covered and what isn't. Don't blame the doctors office for the difficulty in finding that information from the insurance. You should point your anger towards the insurance companies and our fucked up health care system.

 

[DrPizza]

You may be able to pay the doctor, then submit your receipts to your insurance company for reimbursement under a non-participating provider. (Which may not be 100%)

 

[OS]

Originally posted by: Crucial
Isn't it your responsibility to call the insurance company to verify your coverage? Why should the doctors office care if you are or not? They are just processing your claim after you present them with your insurance info. They have no way of knowing what is covered and what isn't. Don't blame the doctors office for the difficulty in finding that information from the insurance. You should point your anger towards the insurance companies and our fucked up health care system.

insurance coverage information is not always readily available, the insurance company's search engine is weak and a rep is not always available, particularly if you need the appt on short notice.

if anything, the doc's office should know which plans they take because this is their damn job and they deal with this every day. I sure as hell don't.
And don't lie and tell me i am covered when in fact i probably am not.

 

[kranky]

Saying "we accept your insurance" is not the same as saying "you are covered".

The doctor's office has no way of knowing what your plan covers. You cover whatever insurance doesn't. That's why you sign the paper that says you are ultimately responsible - because the doctor's office doesn't know what is going to be paid and what isn't.

"We accept your insurance" means they will bill the insurer directly, and IF something is covered, they agree to accept whatever the pre-negotiated fee is.

 

[LostUte]

Originally posted by: Crucial
Isn't it your responsibility to call the insurance company to verify your coverage? Why should the doctors office care if you are or not? They are just processing your claim after you present them with your insurance info. They have no way of knowing what is covered and what isn't. Don't blame the doctors office for the difficulty in finding that information from the insurance. You should point your anger towards the insurance companies and our fucked up health care system.

Actually, insurance companies tell you to verify with the doctor that they are a member of the insurance network.

 

[OS]

Originally posted by: kranky
Saying "we accept your insurance" is not the same as saying "you are covered".

The doctor's office has no way of knowing what your plan covers. You cover whatever insurance doesn't. That's why you sign the paper that says you are ultimately responsible - because the doctor's office doesn't know what is going to be paid and what isn't.

"We accept your insurance" means they will bill the insurer directly, and IF something is covered, they agree to accept whatever the pre-negotiated fee is.

please tell me how you can have a "pre-negotiated fee" but not know if something is covered or not.
the insurance card explicitly states what the insurance plan is.

 

[FoBoT]

if it is any procedure that you can't afford to pay yourself, you need to get a pre-approval letter to be sure they'll pay

our health ins. system kinda sucks

 

[kranky]

Originally posted by: OS

Originally posted by: kranky
Saying "we accept your insurance" is not the same as saying "you are covered".

The doctor's office has no way of knowing what your plan covers. You cover whatever insurance doesn't. That's why you sign the paper that says you are ultimately responsible - because the doctor's office doesn't know what is going to be paid and what isn't.

"We accept your insurance" means they will bill the insurer directly, and IF something is covered, they agree to accept whatever the pre-negotiated fee is.

please tell me how you can have a "pre-negotiated fee" but not know if something is covered or not.
the insurance card explicitly states what the insurance plan is.

In my case, my plan has negotiated fees in advance with doctors who accept their insurance. Silly example: Let's say I go to a therapist who charges $100 a session. The insurance company has pre-negotiated with the therapist to pay $70 a session. When the doctor agreed to take my insurance, he agreed to accept the $70 as full payment.

Now if my plan covers therapy, the doctor gets $70 from the insurance company. If my plan does NOT cover it, insurance pays nothing.

So the fee is pre-negotiated. The doctor doesn't know if it's covered or not, because the doctor doesn't know every detail of your health care plan.

The list of what is covered and not covered (at least in my plan) runs about 12 letter-size pages. It cannot be on your card, nor can the doctor know the intricacies of your specific plan. It's not as though everyone with insurance from XYZ Health Care has the exact same coverage.

 

[BoomerD]

When in doubt, insist the doctor's office confirm coverage BEFORE you see the doctor. That saves lots of these kinds of headaches.

 

[Crucial]

Originally posted by: LostUte

Originally posted by: Crucial
Isn't it your responsibility to call the insurance company to verify your coverage? Why should the doctors office care if you are or not? They are just processing your claim after you present them with your insurance info. They have no way of knowing what is covered and what isn't. Don't blame the doctors office for the difficulty in finding that information from the insurance. You should point your anger towards the insurance companies and our fucked up health care system.

Actually, insurance companies tell you to verify with the doctor that they are a member of the insurance network.

They may be a member of the network but they don't know what your specific plan covers and doesn't cover.

 

[Gothgar]

if you do end up getting screwed you can usually work with the doctors office to not pay full price, you think insurance companies make money by paying for "1500 dollar" MRIs and shit?

 

[nanette1985]

The simple answer is no, don't sign that form that says you are financially responsible.

 

[imported_Baloo]

You really should be talking to your insurance company, or whoever in your company handles insurance issues, about your coverage, not your doctor. Your doctor is not going to know.