AboutTricia Expertise Has your medical insurance company denied your claim and refuses to pay? Have
you received a pre-authorization and still your insurance company
refuses to pay? How can you get your insurance company to reverse a
denied claim? How do you get a provider to waive your copayment if you
are financially unable to pay? Can a provider sue you for a unpaid bill and
will they? Can a provider send me to a collection agency for a medical bill?
If my insurance company does not pay, am I responsible? If you have these questions or others on why your insurance company is not paying your bills, I can help. I can give you "tricks of the trade" to get your insurance company to pay.
I have limited knowledge on Medicare and Medicaid and that is not my expertise. Each state is very different regarding Medicare and Medicaid so you need to review their website when you have questions. So please no Medicare or Medicaid questions!!
Experience In the medical field for over 20 years spending majority of time in the collections aspect.
I walked in a dental office with a toothache, and asked them specifically if they are they are in my insurance plan's network, and if the visit would be covered. They said yes. They even required a copy of my insurance card. After the visit, they gave me a bill stating I had $0.00 to pay.
Subsequently, I received a bill from them stating that my insurance refused to pay, and that I have to pay for the visit. Apparently, the insurance company is correct - the office is actually not in network.
While talking to the secretary at the dental office she told me that "this happens all the time", and people have to pay. She actually laughed. The confusion is because the office is in one plan from the same insurer, but not in the other.
Question is -- what could I do? I have witnesses for the moment when they stated the visit would be covered. Is there a way I can try to fight this? Is this just an honest mistake of their part (one that they do over and over again, according to their own admission), is this an objectionable business practice, or is this even illegal?
Answer Hi Dan!
I would definitely fight them on this........you will probably have to pay something but if you call them and tell them that they "mislead you" and "lied to you" thus not giving you the choice to find someone in your network, you may be able to say pay half. That is what I would offer them and no more.
Insurance companies require their subscribers to be responsible to check before they go to a provider to ensure they are in their network. I know I check my insurance companies website prior to going to a new provider.
However you should be able to trust a Dr's office when they tell you that they are in your network.
You can also call your insurance carrier and tell them what happened and perhaps they may have a policy in case this happens.
