Doctor's bill

[tom81]

My sister had her wisdom teeth removed a few months ago and our insurance denied her claim. The insurance company told us to go to this doctor but the day she went in he was out of network and now they are denying her claim. The dentist's office gave my mom a bill stating she owed $0 because the insurance would pick it up and they never notified my mom before or after the surgery that they were out of network. Now my mom received a bill from the dentist stating she owes $1,000 because the insurance company has denied their claim. I can understand the insurance company denying the claim, even though I think it's pretty shady they recommended this dentist. But shouldn't the dentist have notified my mom and sister that they no longer were in network so they could have found a dentist who was in network? The state this happened in was Ohio.

 

[Beth3]

Actually, it works the other way around. Your mother or sister should have verified with the dentist he was still in the network before having the surgery performed. What likely happened is that in-between the insurance company telling your mother this dentist was in the PPO and the surgery taking place, the dentist withdrew from the network.

It's unfortunate your mom/sister got caught in the middle but ultimately it's their responsibility to select an in-network provider and verify participation if they want the associated savings. Sorry.

 

[tom81]

My mom did verify that the doctor was in network before she made the appointment. She verified this with the doctor and the insurance company.

 

[Beth3]

But did she verify it again at the time of the surgery? Weeks or even months could have passed between making the appointment and the time the procedure was performed.

I agree it stinks your mom and sister got caught in the middle on this but the bottom line is that your mother is responsible for the bill.

 

[tom81]

The nurse told my mom the day my sister had her wisdom teeth taken out that they were in network.

 

[Beth3]

Then I think your mother should have a discussion with the dentist and she if she can negotiate reduction in his fee. The doctor's nurse misinformed your mother and now she's out of pocket far more than she anticipated.