Help! Can anyone give advice concerning insurance?

[Alexandra]

I just found out the worst news I could possibly receive 7 days before my surgery! I accidentally discovered that my surgeon no longer accepts my health insurance! His contract ended in September- four days BEFORE I started seeing him with my new insurance- I've seen him twice since then, and no one (Not his office, nor the insurance company themselves) informed me that I wasn't covered AT ALL. I am to have the fusion on Friday December 16- I can't believe that they were not ever going to tell me! I found out because the doctors office sent me a bill on a couple days ago for my consultation in September. It listed that a portion of the bill was 'expecting payment' from the insurance company. The way my policy works- is that, as long as it is in network, they pay 100%, so I called my insurance and found out the bad news. If they would have informed me of this sooner, I could have upgraded my insurance to cover a portion of out of network provider. As it stands, my insurance company will not pay ANYTHING towards an out of network provider!

My question is- does anyone know of any laws that hold a doctor's office accountable for their mistakes regarding insurance notification? (They are well aware that they made several mistakes- and are going to call me back tomorrow to let me know if there is anything they can do.)

Thank you for any help! I pray everything works out because I really need this surgery!

[SpineWhine]

Your insurance company should have an appeals process - a sort of way to make an exception to their rule. The Doctors office can help with that by communicating with your insurance company about what happened, and why they should make an exception to keep you in network. (ANd, unfortunately, it will probably play out that because your insurance is a contract between you and the insurance company, the doctors office isn't going to be responsible for miscommunications with you and your insurance because the contract isn't between the two of them. So, really it is the insurance company's fault for not communicating properly with you... which is why they should make an exception. Read your policy and see what you can do to appeal the coverage...) And, you may want to seriously postpone having the surgery since it is such a huge deal financially, and you may ant to have this all straightened out first. (Either by making sure your insurance will cover yourpresent Dr, or finding a new Dr that your insurance will cover.

I am having surgery on Tuesday 12/13 - I can't imagine the stress this is causing you at the last minute. I know I would be beside myself! Good luck...

[Karen Ocker]

Usually, if you've started with a doctor in network, and then he becomes out-of-network you can get the insurance company to continue payments for a particular illness. Sometimes all you have to to is ask. Also, if your insurance is through an employer, they will often go to bat and solve this. The employer's human resources/benefits department is the one to contact.

Other ideas: check with your state insurance department. (this happens a lot with obstetrics). Get everyone's name you speak with and keep a log. Also always ask for a supervisor.

How horribly stressful. Keep us informed.
Karen