Question
What is the name of your state? New Jersey.
I am in NJ PLUS insurance. I wrongly choosed an internal medical docotor for my son's PCP. Therefore, I went to a pediatrician who is in NJ PLUS network but I did not register him to be my son's PCP. The pediatrician accepted my son's visit but called me a month later said the insurance company refuse to pay the bill because I did not register him before visiting. The pediatrician is in-network, but the insurer treats him as out-of-network just because I did not register him as PCP. Also, the pediatrician did not check if he is my son's PCP and accept the visit. My question is who is at the fault and shall pay the out-of-network bill?
Thank you.
Answer
What is the name of your state? New Jersey.
I am in NJ PLUS insurance. I wrongly choosed an internal medical docotor for my son's PCP. Therefore, I went to a pediatrician who is in NJ PLUS network but I did not register him to be my son's PCP. The pediatrician accepted my son's visit but called me a month later said the insurance company refuse to pay the bill because I did not register him before visiting. The pediatrician is in-network, but the insurer treats him as out-of-network just because I did not register him as PCP. Also, the pediatrician did not check if he is my son's PCP and accept the visit. My question is who is at the fault and shall pay the out-of-network bill?
Thank you.
It's your policy and you're still at fault for not having the physician you chose as the PCP on your insurance. We see this often at my office, unless your PCP is in a group practice, and you chose Dr. A and Dr. B saw your kid. Then you could tell your carrier, B was covering for A and that they are in a group practice.
Otherwise, you're outta luck and the pysician is within his rights to bill you for services.