AboutLinda Woolsteen Expertise I can help you with questions about health insurance. If you feel your insurance company is mistreating you. Are they telling you they are checking eligibity, pre-existing, etc. Or you just don`t understand how your insurance works or don`t understand what a PPO is.. I can help you.
Experience
Past/Present clients One company I worked for I was the underwriter for the Academy of Medicine of Cleveland and the Ohio Bar Association. I was also a supervisor of our customer service department.
Question Our insurance co. changed as of June 1. My 2 daughters saw the MD on June 2, gave the office their new insurance cards, which they made copies of, and saw the MD. One of the girls had a second appointment there that same week. No mention was made that they did not accept this insurance. A week after the girls were seen, the office called to say that the woman who handled the insurances at the office had been on vacation and that they did not accept our insurance. (Shouldn't someone else be available to handle these things in her absence?) Should we be held responsible for these 3 office visits and lab work even though we gave them copies of the new insurance cards?
Answer I am sorry, but yes, you are responsible. It is up to the Insured to make sure that their providers are in network. It is not up to the providers. There are many different insurance companies and plans out there and there is no possible way for the provider's office to keep up with them.
Just so you know, if they send you outside of the office for x-rays, labwork, etc. It is also up to you to make sure that those providers are in your network. Just because your provider (that may be in network) sends you somewhere, does not mean that the provider doing the work will be in network. The same applys when you visit a hospital. The hospital may be in network but many ancillary physicians (anesth. labs, xray, especially ER physicians) are NOT in any network. HOWEVER.... most insurance companies, will process the ancillary physicians claims toward your innetwork benefits to help you out, if the hospital is in network. BUT, it is not automatically done. You would need to watch your claims/EOBS and if the ancillary providers claims are processed toward your out of network benefits, you would need to call your insurance company & tell them the hospital was in network & ask if they can reprocess the ancillary providers claims also toward your innetwork benefits.
All you can probably do at this point, is apologize to the doctors office that you did not understsand that it was your responsibility to keep up with that and ask if they will give you a break this time.
Another word of advise, working inside an insurance company & being able to speak to over hundred's of providers daily, nationwide, I have a good overview of how things operate and MANY, provider's offices are not even sure all the time of the plans that they are in network with. It seems to me that sometimes the doctor or office manager signs up with plans & then that information does not always get passed on to all other people in the office.
The person that copies your card at that office, probably, just does that, the initial taking of information. It would have been nice if she paid a little more attention and/or knew or cared to watch what was transpiring beforehand. To me, that, intial contact witht the person taking your information at the hospital or doctors office is a very big, important task. It all starts with them. If anything is incorrect, it gets passed on down the road to the labs, etc. and then it is a mess to try to get it all corrected down the road. So, always watch when you check in at a hospital especially what they have down on your paperwork when they give it to you.
