Insurance company refuses to pay

[priscillablue]

What is the name of your state? VA

I have a question regarding a charge from an eye doctor. I had a LASIK procedure done several months ago. At that time, the doctor did a special procedure (punctal cauterization) to avoid dry eyes. The doctor's office told me at the time with great certainty that my insurance would cover the procedure. But now apparently my insurance company (an HMO insurance) is refusing to pay for the expense because no referral from my primary care doctor was provided. So I'm receiving a bill from the doctor's office for several hundred dollars. Am I under the obligation to pay? Is there anything I can or should do to solve the situation at this time? Thank you for your help!

 

[cbg]

The doctors office's assurance that the insurance company would pay, is not binding on the insurance company. THEY are the ones who decide what is and is not covered under your policy, not the doctor.

If your policy requires a referral from your primary care provider and you did not get one, then they are not obligated to pay the bill. You, however, are. You are responsible for knowing what your insurance policy says. If you don't know, you read the policy. If you can't understand it, you call them and ask.

The ONLY possibility here depends on your policy. IF your particular policy makes it the responsibility of the treating physician to get a referral, then you MAY have an out - UNLESS it was your responsibility to let the doctor know you needed a referral in the first place. The only one who can answer this for you is your insurance company. You need to call them and find out what your options are. Be prepared, though, for hearing that the bill is your responsibility.