Insurance/medical billing cross-question?
A patient call a doctor and provides correct insurance information, the office say "yes we take that", you provide your insurance card when you arrive, they trademark a copy, you have your appointment, you evacuate. Some time later you return with a bill for hundreds of dollars from the doctor. "we don't take your insurance, you hold to pay" or "we take Blue Cross but not the Blue Cross you have". Can they force you to compensate? Are there any regulations almost this? It happened to me (I tried to face-off it but got nowhere and I rewarded 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 reasonable that the patient should hold to pay surrounded by a situation like this.
Answers:
Technically, it's the patient's duty to confirm that the provider is contracted next to the insurer prior to accessing service. This can be done by any calling the insurer or going to the insurer's web site (all insurers are required to hang on to their web provider list up-to-date). (I do not recommend you use the printed provider list, since it's pass¨¦ almost as soon as it's created.)
On the other hand, the provider's department had the responsiblity to give an account you when you gave them your card that they don't enjoy a provider contract with your insurer. That opening, you could have made an informed judgment whether or not you would access care nearby.
So in actuality, both parties (you and the doctor's office) be wrong. You could speak with the doctor and discuss this, but you might not find too far. The most you should probably hope for is a reduction contained by the bill.
If you want to know whether there are any insurance statutes or regulations in relation to this issue, call the insurance commissioner's department in the state where on earth the BCBS franchisee is located. (For example, if you have BCBS of CA because your employer is base there, but you live/work surrounded by FL, you should call the CA commissioner's bureau.)
I'm sorry I couldn't give you guidance that's more encouraging.
this is something that you and the doc would hold to address. Unfortuntally. I work for an insurance company and I hear this all the time. it sucks and I know how you touch There isn't anything the insurance company can do for you. As they stated they participate next to you and accepted you as a lenient, then you involve to talk beside them! Its a hard rock and a soft spot! Good luck!
Yes, they can force you to pay cheque. The doctor can't be held to "yes we take that", ESPECIALLY over the phone.
You HAVE to call upon the number on the back of your card, to see which providers are CURRENTLY beside the plan. AND, it's subject to change in need notice!!
somewhere on the information you filled out back you saw the doctor you agreed to be responsible for paying the bill, whether the insurance company pays or not. Now in your casing you could have call the doctor's office explained that you would never hold used them if you had prearranged they did not take your insurance and that you assume you were mislead surrounded by the process. You could also have threatened to report them to the better business bureau etc. Probably they would enjoy drastically lowered the bill or dropped it all together.