I am being charged by my doctor because insurance do not want to pay them because he is out of network.?

Question

I verified with the doctors office before bringing my son for his eye check-up that they are in network and they said yes. I paid the patient part, the health insurance does not want to pay them because their contract expire with this doctor and they are now out of network. It is not my fault and now they are charging me, please help?

Answer 1

You NEVER verify with the provider that they are in network, you ALWAYS verify with YOUR SPECIFIC plan. (You call member services, give them your ID number and ask what's pertinent to your individual plan.) There are hundreds of insurance plans out there, with just as many networks. Doctors do try to belong to all networks of the major plans, it's not always possible. For example - if you have an out of state based plan, it often means you pay more out of pocket because the provider may not be in that specific network.

Sorry, but the burden here is on the patient. You can call the billing manager and ask if they can work a discount for you, then get the claim form and turn it into the insurance company for them to pay you, but they don't have to do that. Don't go to the doctor directly. Most of them hire billing personnel so they don't have to get involved in disputes like this. The doctor's primary concern is to treat the patient, not worry about getting paid for it.

Answer 2

It's not up to the doctor to make sure they are in network with your insurance company - it's up to YOU.  

So, you're looking at two different transactions - one between you and the doctor, and one between you and the insurance company.  

It's your fault - you didn't check with your insurance company to verify that the provider was in network.  You will have to pay based on out of network charges.  Your doctor will sue you for payment for services rendered, and he'll win.  Plus interest & legal fees.  

Sorry.  Expensive lesson learned - ALWAYS call the insurance company to make sure that the doctor is STILL in network.  BEFORE EVERY VISIT.

Answer 3

Unfortunately, you are ultimately responsible unless you can get the doctor to adjust the bill.  They are not obligated to do so.  Next time, verify with the insurer, not by taking the word of the provider.

Source:  experience.

Answer 4

try to speak with the billing manager. if you have the name and time and date that you got the misinformation that would be helpful. if you get no where with the office manager or billing manager you could try to talk to the dr about it. someone there has the authority to write it off, and they should if their office staff is giving out bad info. not guarenteed, but a chance.

good luck. i hope you find a new dr in network! it is best to get a list of drs in net from the insurance company-or online website to find a dr in network, HOWEVER,i had a case just this week where the website was outdated. the pt told me she 'researched carefully' her choice in order to be in net. i went to the website she was looking at and there was a disclaimer at the bottom of the page' we try to keep the info as updated as possible, but check with the provider directly before signing up to make sure the info still current' well this lady did not call us. the other thing is when checking with the provider it is good to ask for the contracting office, they negotiate which plans are in or out, so you have a better information source than the front desk person when calling. well that is if it is a hospital. dr offices probably i would go with the billing manager when inquiring. hope this helps!

Answer 5

It is usually best to verify with the insurance company, not the doctor's office, although I understand why folks assume that calling the doctor's office is the way to handle it. Staff at doctor's office tend to come and go, whereas you can easily consult a provider directory of the insurance company to see if that particular doctor is still a provider. The thing to remember is that ultimately the patient is responsible for payment of the bill, not the insurance company. You may have to fight this one out with them.