Im being billed $4000 b/c the dr i went to says they are not in my network, i called and asked if my insurance

Question

was taken there and they said yes, now that im being billed i called them and said i wouldnt of seen that dr if they told me they didnt take my insurance and she admitted that they were just starting up and the girls didnt know what they were doing and they have been having a lot of complaints about this. should i have to pay it. she is telling me that no matter what they say that i should of known myself?

Answer 1

Technically, it's the patient's responisibilty to know whether or not the doctor they're seeing is in their insurance network. Some of the larger plans (Aetna, Cigna, Blue Cross/Blue Shield, etc.) have hundreds of networks, and it is possible to participate in that plan, but not in that network. (It's most common with out-of-state-based businesses, but it can happen anywhere.) You should have verified the information with your specific plan.

Yes, you do have to pay it. You saw the doctor, didn't you? If you don't pay up, it can be construed as theft of service. At the very least, the office will send you to a collection agency and s***w your credit, or they'll sue you for payment - and they'll win, or, worst-case senario, you'll be prosecuted for the theft of service.

The only thing you can do is ask for a discount. Keep your receipts - you can probably turn it in to your insurance plan and be reimbursed, otherwise, you might be able to write it off on your taxes.

Answer 2

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Answer 3

Technically, yes...it is your responsibility to confirm directly with your insurance company whether or not the provider is in network.

Also, a provider saying that they "take" your insurance is not the same thing as them specifically telling you that they are "in-network."  (Many providers are still willing to schedule appointments with out of network patients...which is what they mean when they say that they "take" your insurance.)

Now, since you may have had a miscommunication with the doctor's office, the honorable thing for them to do would be to work out a discount with them on your balance and a payment plan for the remainder.  (But technically, they aren't legally obligated to do so.)

In the future...check directly with your insurance company about the network status of your doctors.  There are so many different plans out there from the various insurance companies, that you can't be absolutely certain you're getting the right info from the doctor's office.  (They may participate with some plans from a particular insurer, but be excluded from others with that same insurer.)

Answer 4

Yes, you have to pay.  It is ultimately your responsibility to check with the insurance company as to whether a specific doctor is in your plan network.  NEVER take the word of providers' front-desk staff (I also learned this the hard way).

Answer 5

First

Call your insurance company and explain the situation, possibly if the doctors office fills out a few forms he can be approved for the network so that your bill can be paid.

If your insurance company refuses to help you resolve the issue, go back to the doctors office:

Second

If the doctors office took your insurance information and told you that your insurance was accepted, and now you've found out that it is not, I would tell the doctors office that you are hiring an attorney to file charges against the doctors office. Then tell the doctors office you are also going to write and article to the editor of your the local newspaper about your experience with the billing issues.

In my opinion, I rather pay an attorney $$ then a bill for $4000.00 that I shouldn't have had to pay.

Third

Call the state Division of Insurance and talk with the Director, they can help you resolve the issue.

It's not hopeless............

Good Luck To You

Answer 6

I am amazed at how many folks find themselves in the same situation in which you find yourself.  NEVER EVER rely on what you are told by a doctor's staff.  You should be calling your insurer to find out whether or not a specific clinic/doctor is in the network.

The best you can do now is to try to negotiate a lowered fee and try to work with the insurer who MIGHT pay an amount based upon what they would pay to an in network doctor.

Good luck.

Answer 7

~~You are never safe unless you actually verify if a Doctor is a provider directly with the insurance company. Find out from your insurance co. what your out of pocket costs would have been, if the doctor was a provider. You will need to know exactly what the doctor is billing you for, sounds like you had a procedure of some sort done. The office can give you the billing codes. Once you have this info from your ins. co. call the Doctor's office back. Since they admitted to their mistake, they should be willing to take responsibility. Tell them you want to just pay as if they were a provider and ask them to write of the rest.  They may be good enough to do this, if not-you can take them to small claims and let a judge decide. However-just so you know, unfortunately the responsiblity is up to you to know who is under your network.~~