AboutR. Gene Ramsay Expertise I can answer questions from people regarding health, life, and supplemental insurance. I can also answer certain annuity questions,
long-term care, medicare, vision, dental, group products, individual
products, and certain carriers. Another area would be general discussion on an individual basis to determine need and help individuals make the right decisions for them. I can also field questions from other insurance
providers about carriers I represent so we can do some business together and I am also willing to offer my thoughts on certain issues they may be having
with clients/customers, etc.
Experience
Past/Present clients I would prefer not to divulge current clients without their consent to do so.
Question I had a MRI done at a facility I was told accepted my Blue Cross/Blue Shield
Insurance. Now Im being billed because this facility is not a participating center.
This facility never called my Insurance carrier to confirm my eligibility and Im
stuck with the bill. This was clearly not my fault.
Answer Raph,
I usually answer questions people have, but will comment on your comment anyway since you took the time to send it.
Situations like this do happen and MRIs seem to be major culprits for this type of issue. The doctor who assigned the MRI should have checked to eligibility as well as the facility that did it to be sure there would be coverage. MRIs are not cheap and they do owe it to you to at least tell you whether or not they will honor your insurance on this. In fact, many times, they will preauthorize through your insurance and will not proceed until they have that approval from your carrier. Now, if it was a serious situation your doctor may have done that but the carrier may have stalled and the doctor could not wait due to your situation. The doctor had your best interests at heart for your health, but did not think about a bill. I will assume that the MRI told your doctor what they needed to know.
Know this, there will be a record whether or not they tried for preapproval in your medical records. They can either verify their moves or you can ask to see your records for yourself to see if they do. Usually, I go in and ask the doctor/facility what their practice and Standard Operating Procedure when they prescribe or get an order for an MRI. Again, the doctor you saw ordered it and should have done the preapproval. All a facility knows is what the doctor tells them so they can turn on the machine and do what he has asked.
Lastly, many facilities are willing to work with you if they won't budge on the bill. If you find out that your doctor or they did not do anything on preapproval, then it becomes a negotiation on your part. Just remember, your doctor had your best health interests at heart and not your wallet. The facility was only doing what they were asked to do. Now, if the doctor and the facility are one entity they really should have had no issue verifying the MRI with your carrier.
Good luck and just take it one step at a time with those parties involved. Getting the answer to the "norm" for them in these proceedings will go a long way to your understanding so when you go back to the parties involved you have a legitimate shot at getting the outcome that is right. Final tip...write everything down as you get into it. Names, dates, etc.
