I was going to a center for pain management. The doctor did a procedure on me, By the way It didn't even work! He said the insurance would pay for this. I've appealed the insurance company on several levels. They said the procedure was an expierimental one and that they would not pay.The doctor assured me it wasn't and said there was plenty of medical documentation on this and said they would have to pay it. Now the doctor is sending me bills wanting thier money. I'm out of work and can not pay this bill as it is in excess of a thousand plus. What can I do? I would not have had this done if the doctor hadn't assured me that the insurance company would pay! Do I have any type of recourse? Thank you .May GOD bless!

If the provider was a participating provider, and the procedure was indeed experimental the provider should have gotten prior authorzation to perform the procedure. If preauth was required but not obtained by the provider you are not liable for the amount. If the procedure is only considered investigational by the plan... you may not have any recourse.

This is a good lesson. Never take a doctor's word for what is covered by insurance. Always personally call the insurance company yourself to verify before proceeding. Hope the doctor is at fault here and you don't end up having to pay all that money..

I have this to be a good practice to call the insurance co first and ask. I always get books with Doctors on them that I know dropped the insurance years ago but they fail to take them off.
Or you call a Dr and say do you take this insurance and the girl always says yes we do, well some doctors say that and they are not on the provider list so you get a huge bill. Just because they accept it doesn't mean your safe.
Call them and ask again at the window if you don't call the Ins Co first!
We learn and learn. :eek:

You may be able to appeal to the State Department of Insurance or Administrative Law Judge in your state. In the meantime though, you are still responsible for the bill.

I would not just pay that kind of bill. I'd go to the doctor's office and explain to him just what you told us and ask him what he wants you to do, since the insurance isn't paying as he promised they would. Tell him you want to make sure this doesn't happen to anyone else, that he needs to advise his patients to find out from their insurance whether it will be covered, and that he needs to never make that assumption again so no one else is stuck with a $1000 bill. Be sure to say all of this in a very nice (not rude) manner. I'm very curious what his response will be. Ask that the bill be reduced to actual cost only rather that a bill that gives him a profit. If you end up having to pay the bill, you will either need to ask for a payment plan or refuse to pay, and it will affect your credit forever. This is a horrible situtation, and I don't think it's your fault at all, and I really really feel for you!

I was going to a center for pain management. The doctor did a procedure on me, By the way It didn't even work! He said the insurance would pay for this. I've appealed the insurance company on several levels. They said the procedure was an expierimental one and that they would not pay.The doctor assured me it wasn't and said there was plenty of medical documentation on this and said they would have to pay it. Now the doctor is sending me bills wanting thier money. I'm out of work and can not pay this bill as it is in excess of a thousand plus. What can I do? I would not have had this done if the doctor hadn't assured me that the insurance company would pay! Do I have any type of recourse? Thank you .May GOD bless!

First, I would arrange to pay the physician $10-$20.00 a month, until it is paid off. Second, if you do not have a job or income, they can get a judgement, but, without something to garnish, they are out of luck. Third, explain to them that you are out of work and make a small payment plan. Fourth, they might give you alot of noise, however, unless there is something of value to legally attach, they have little recourse in this matter. By the way, government checks like unemployment compensation are not garnishable in court. The maximum that the court can order taken out, is 25%.

Mark

If the Dr. assured you that your Insurance will cover the procedure then I feel that the Dr. is liable. I also have blue cross/blue shield and was told at the hospital that when I come back to get my stiches out it was at no cost..then I had a bill sent to me from the hospital in Ins. Blue cross said it wasn't paying because it was not an emergency and the hospital said since the ins. isn't paying them then I'm responsible. I explained the sitaution and what the Dr. had told me. Lucklily, after several phone calls, they decided to not charge me and had a talk with the Dr.

I would try and fight the Dr.'s office. Finacially this wouldn't hurt the Dr.'s office at all, but for you who is out of work..this is a big deal. The Dr. told you something that was incorrect therefore unless you signed anything regarding this I would pursue the Dr.'s office. I would refuse to pay.

My parents just went thru a similar situation -- Mom didn't want to have a test done. Knew it was expensive, didn't think it was necessary. They were assured it was covered. Then it wasn't. Then they had problems with the doctor's office -- lied and indicated my mother demanded to have this test. Sent a collection agency after them. Was a nightmare. I just told them to tell the collection agency that the case is in dispute and they backed off. Sometimes it's just a matter of how the doctor writes down the item when it's filed for insurance and it can be changed. I think if you have documention you can refile it with the insurance company to have the claim re-evaluated.

I'm sorry you're going through all this hassle with your insurance company and the doctors' office. I don't know that I have a whole lot of advice for you - but I do have Carefirst BlueCross. My daughter recently (about 8 months ago) swallowed a calculator battery (How a 9 year manages this is beyond me!).

I had an issue where the Emercency facility that I brought my daughter to did not get a pre-auth for surgery prior to scheduling this surgery with the hospital. My daughter's surgery ended up starting 40 minutes late because I thought to call the insurance company to ask if this would be covered prior to signing her in. Fortunately, I have an **incredible** primary care physician's office that went ahead and got me the referral, even though it was the responsibility of the Emergency Care Facility. The surgery went off with no problems and I didn't pay a cent of it.

However, the only reason I knew to call the insurance company ahead of time to check was because I knew situations like yours come up, and I've had to pay out of pocket for procedures because I didn't think ahead.

I will say on the issue of judgements .. avoid them at ALL cost. I'm in the mortgage industry and look at credit reports daily - a judgement REALLY hurts your credit and prevents you from being able to qualify for a loan without full payment on the judgement. I would talk to the doctor, see if they'll discount the procedure, keep on fighting the insurance company - if nothing else, most insurance companies will do an 80/20 in a situation like this. I would also work out a deal with the doctor's office so they don't send collectors. Once a collector is called in, it goes on your credit report - though not as a judgement until the collector goes to court for it.

Good luck to you!

I can't offer you any advice but I know what you are feeling. I too have BC/BS and am having problems getting them to cover anything.

My neighbor had the same problem getting things covered and ended up having to sue the ins co to get it covered. :rolleyes:

The more people I talk to with this ins co the more I hear about the negative things. I know from my experience dealing with the ins co they are rude and uncooperative to top it off.

Each time I try to call the ins co to find out something or what I can do I always get some idiot on the other end that sounds like they just crawled out of bed and is unwilling to help or point me in the right direction.

I hope you get your problem resolved soon.

I too have Blue Cross...and went through the same thing! I was tossed around all these different doctors when i was away from home using that away from home care thing. They sent me to a doctor who wasnt on the list but they said he was...and he sent me to get tests done with he didnt get a referral because he didnt look to see it was HMO not PPO. OMG that was a horrible horrible thing!!! lol But I eventually got them to pay for every last bill...every single one...and I had like thousands of dollars in them and Im only 19...this was not an easy task being as it was my first time doing this...I was way over my head :p But I called and called repeatedly...and I recommend this to anyone...whether its getting a sooner appt...or dealing with bills...calling repeatedly and just being nice...they eventually give in. Always write down the name of the person u spoke to and call them by their name when u talk to them...they are more likely to help you lol Just some tips ;)

I have OXFORD and it has been superb (except for the $600.month payment.) Everything is on-line and all referrals and pre-approvals can be thoroughly checked.

If a doctor or a hospital is a participating Oxford member he agrees to accept whatever is contracted for the particular procedure. If the amount is decided by the insurance company to be ZERO, the doctor can fight it out with the company if he chooses, but it does not in any way involve me. If they finally agree to pay him zero, he can stay in plan or drop out. In any case I owe hin my $20 deductible and nothing else.
Any bills will go into the circular file.

A doctor who chooses to hector patients to get some extra money out of them is guilty of harassment and would suffer in a court of law!

I have OXFORD and it has been superb (except for the $600.month payment.) Everything is on-line and all referrals and pre-approvals can be thoroughly checked.

If a doctor or a hospital is a participating Oxford member he agrees to accept whatever is contracted for the particular procedure. If the amount is decided by the insurance company is ZERO, the doctor can fight it out with the company, but it does not in any way involve me. If they finally agree to pay him zero, he can stay in plan or drop out. In any case I owe him my $20 deductible and nothing else.
Any further bills will go into the circular file.

A doctor who choses to hector patients to get some extra money out of them is guilty of harassment and would suffer in a court of law!

As for a one year restriction on pre-existing conditions, it's quite common and there's nothing you can do about it- it's contract law.
BUT I don't see how they can wash their hands of it if you wait the three month necessary to make it a year.

An aside: Is it endometriosis?
Read your contract carefully.

The doctor should not charge you for the procedure. If he indeed said it was covered and not experimental...He should eat it...I do not think medical bills go on your credit record, but do not quote me on that one!

I am in no way defending the health insurance companies, but because the cost of healthcare and insurance is so crazy, we, as consumers need to take more responsibility with our own healthcare.
Educate, educate, educate. I can't say this enough. It's not like it used to be - Just go to the doctor, pay a tiny $10 copay and everything is covered. It doesn't work like that anymore.
LEARN about your healthcare plan - Ask a TON of questions and if you feel you're not getting the answers you need, ASK MORE QUESTIONS! Know how your plan works, make sure your seeing doctors and facilities in the networks of your plan, and don't ask your doctor! He/she won't know the answers - Call your insurance company and ask them.
Time and time again I see people complaining about their insurance - DO SOMETHING ABOUT IT! Take the inititive and and educate yourself on the ins and outs of how your plan works. There are many plans out in the market these days and not all of them are good ones.

Yes medical bill DO go on your credit report. It happened to me b4 i joined b/c b/s. I never have a problem w/ bc/bs.