What is the name of your state (only U.S. law)? North Carolina
Precertied for preventive procedure through Urologist--an in-network provider. Dr. performed the procedure at several medical facilities--and I chose based on day of the week that he'd be performing the procedures at the facility. The facility itself is out of network. At intake I provided my insurance card and signed the financial agreement form--that itemizes several terms. The first "I agree to pay for all medical services provided." As well, I assign fiduciary responsibility to the provider, "Please apply for any health insurance coverage that may be available to me." "I appoint (Medical provider) as my 'authorized representative' to act for me in getting payment for services provided." My insurance card states, "Provider must call (number) to obtain pre-authorization." Following the procedure I received a bill from the medical provider for around $5000. I appealed to insurance. Insurance company ruled the claim to be a "post-procedure claim." I noticed it did not refer to it as an out-of-network provider. I also confirmed with my insurance that the medical provider did not call to get the procedure pre-authorized--but the Dr. performing the procedure did. During my appeals process with the medical provider customer service manager I was told my bill would not be sent to debt collector until my complaint was reviewed. I received a voice message from customer service executive--but no info about the decision. I left a message with the executive and waited to receive follow up. Instead within a few days I received notice from a debt collector. I have filled HIPPA complaint due to transfer of info to debt collector. But I'm wondering if I would have a case against the medical facility for failing to pre-certify?
Precertied for preventive procedure through Urologist--an in-network provider. Dr. performed the procedure at several medical facilities--and I chose based on day of the week that he'd be performing the procedures at the facility. The facility itself is out of network. At intake I provided my insurance card and signed the financial agreement form--that itemizes several terms. The first "I agree to pay for all medical services provided." As well, I assign fiduciary responsibility to the provider, "Please apply for any health insurance coverage that may be available to me." "I appoint (Medical provider) as my 'authorized representative' to act for me in getting payment for services provided." My insurance card states, "Provider must call (number) to obtain pre-authorization." Following the procedure I received a bill from the medical provider for around $5000. I appealed to insurance. Insurance company ruled the claim to be a "post-procedure claim." I noticed it did not refer to it as an out-of-network provider. I also confirmed with my insurance that the medical provider did not call to get the procedure pre-authorized--but the Dr. performing the procedure did. During my appeals process with the medical provider customer service manager I was told my bill would not be sent to debt collector until my complaint was reviewed. I received a voice message from customer service executive--but no info about the decision. I left a message with the executive and waited to receive follow up. Instead within a few days I received notice from a debt collector. I have filled HIPPA complaint due to transfer of info to debt collector. But I'm wondering if I would have a case against the medical facility for failing to pre-certify?