Question
What is the name of your state?What is the name of your state? Colorado
My wife visited a walk-in doctor in our network-UnitedHealtecare, he precribes 8 sessions of physical therapy for a knee problem. Wife goes out to same recepitionist in same office and makes appointments. Comes back for 6-7 appointments to see the physical therapy doctor, each time presenting UnitedHealtecare insurance card and $20 co-pay.
Now the paperwork is finally coming back and physical therapy doc is not in our insurance. Now I have to pay him big money. My regular doc sent use to a doc in the same office but not on our plan. No one ever told us this info.
Whos fault is it? Can I sue? Receptionist made copies of insurance card and accepted $20 co-pay, each time, even if the doc is not on my plan.
Feeling cheated.
Answer
Q: Whos fault is it?
A: Yours. You are required to know what doctors your insurance covers.
Answer
What is the name of your state?What is the name of your state? Colorado
My wife visited a walk-in doctor in our network-UnitedHealtecare, he precribes 8 sessions of physical therapy for a knee problem. Wife goes out to same recepitionist in same office and makes appointments. Comes back for 6-7 appointments to see the physical therapy doctor, each time presenting UnitedHealtecare insurance card and $20 co-pay.
Now the paperwork is finally coming back and physical therapy doc is not in our insurance. Now I have to pay him big money. My regular doc sent use to a doc in the same office but not on our plan. No one ever told us this info.
Whos fault is it? Can I sue? Receptionist made copies of insurance card and accepted $20 co-pay, each time, even if the doc is not on my plan.
Feeling cheated.
I want to focus on the "no one ever told us" part. If you have a plan document from your employer, it would tell you that it is your responsibility to determine when / if providers are "in network". Given that providers are in multiple networks and someone else usually negotiates their networks for them, providers often do not know who is in what network. UgHHH, neither do you, but it is your responsibility to find out. I'm also betting that somewhere in here, your providers had you sign something to state that you are responsible for all amounts not paid by insurance. Providers most often do make calls to verify coverage and level of coverage. Your best bet is to try to argue this with your provider. Although nothing binds them to any information or misinformation they gather, you need to impress upon them that perhaps they gave you the impression that inurance payments (whatever they were) would be accepted as payment in full. Unfortunately, I think you have fallen into the trap most folks do--i.e. insurance will pay anything just because you have it--but, not the case. But, I'm all about being practical. You will almost surely lose an appeal with your insurer (read that appeals process also), but services are alway negotiable. Never let it go to the point of collections. lkc15507
Answer
The billing people finally called back. The therapy doc is a sub contractor of our regular in-network doc. So she is cancelling all the incorect billing.
Thanks
Answer
I am glad that this seems to be working out for you. I almost hate ;-) preaching, but do remember the things posted for you in the future. Providers make errors, insurers make errors, but the ultimate responsibility always belongs to the insured. Network issues and coverage issues. Keep all of your paperwork and be familiar with your employer plan document. Ask for predeterminations when time allows. Best, lkc15507