Question
What is the name of your state?What is the name of your state? Wisconsin
My wifes provider refuses to pay for a claim. The original pediatrician (in plan) referred another pediatrician because she could not be their for the birth of our child. The problem is the pediatrician she referred was out of plan and the insurance company refuses to pay for his services which were not required. The insurance company called it a non-emergency preventative measure.
I feel that we should not be held financially responsible for this because she failed to give us a list of doctors that she would refer. Had we known, we obviously would have picked someone else in plan or prepared financially for it.
Any advice on weather or not we should fight this and how would be greatly appreciated.
Answer
Did you specifically ask for a referral to an in-plan doctor?
Answer
I belive we signed a form stating that the 1st option is to use doctors that are in plan. If it got to the point where they ran out of options and used a doctor that was out of plan, that doctor would be covered in the event of an emergency. Which still leads to my confusion, a situation such as this where the doctor was required because of the baby's condition but yet not an emergency, and that's why they will not cover it.
Answer
I work for an insurance company, and I can tell you that doctors don't keep listings of who is in the network, and who is not. That is why there is a little phone number for customer service on the back of your card. They will be happy to look up a listing of doctors for you.
As for the bill, sorry about it, but you are obligated to pay it.