+ Reply to Thread
Results 1 to 12 of 12
  1. #1
    OB Terry is offline Junior Member
    Join Date
    Jan 2011
    Posts
    4

    Doctor is dropped by insurance co - any obligation to inform me?

    I visited my dermatologist in December. I've been a patient of his for over ten years, but had not been there in well over a year (for dermatology, you don't have to). I've used the same insurance (Blue Cross/Blue Shield) for the entire time.

    Since it had been over a year, I had to fill out all the paperwork again, my health history, employer, and of course insurance. I gave them my card to copy at their request.

    Then I had some in-office minor surgery.

    Now I get the bill - for essentially the entire thing. What the doctor's front-office staff did not tell me, nor were there signs, nor did I get a letter, is that BC/BS dropped him in May 2010.

    So his services are considered out-of-network: I start an entire separate deductible, I pay the excess over everything the insurance didn't pay, etc, etc.

    OF COURSE I KNOW that I have to protect myself, but I am being told over and over again by interested friends and co-workers that there should have been some positive communication of this change, by the staff or by letter or by sign.

    I want to negotiate the price with him, since I bear responsibility but I think he bears some, too.

    What is your opinion of his culpability, professional, ethical or otherwise?

    I appreciate being able to ask this question.

    What is the name of your state (only U.S. law)? ILLINOIS
  2. #2
    cbg
    cbg is offline Senior Member
    Join Date
    Nov 2001
    Location
    Massachusetts
    Posts
    33,448
    Was he dropped from BCBS ENTIRELY? Or only for some of their networks?

    It is not at all unusual for a doctor to participate on only some, and not all, of an insurance carriers networks; on the HMO and not the PPO, for example.
    Two things I am tired of typing: 1.) A wrongful termination does not mean that you were fired for something you didn't do; it means that you were fired for a reason prohibited by law. 2.) The above answer, whatever it is, assumes that no legally binding contract or CBA expressly says otherwise. If it does, the terms of the contract apply.
  3. #3
    lealea1005 is offline Senior Member
    Join Date
    Jul 2006
    Location
    supratentorial region
    Posts
    2,603
    Quote Originally Posted by OB Terry View Post
    I visited my dermatologist in December. I've been a patient of his for over ten years, but had not been there in well over a year (for dermatology, you don't have to). I've used the same insurance (Blue Cross/Blue Shield) for the entire time.

    Since it had been over a year, I had to fill out all the paperwork again, my health history, employer, and of course insurance. I gave them my card to copy at their request.

    Then I had some in-office minor surgery.

    Now I get the bill - for essentially the entire thing. What the doctor's front-office staff did not tell me, nor were there signs, nor did I get a letter, is that BC/BS dropped him in May 2010.

    So his services are considered out-of-network: I start an entire separate deductible, I pay the excess over everything the insurance didn't pay, etc, etc.

    OF COURSE I KNOW that I have to protect myself, but I am being told over and over again by interested friends and co-workers that there should have been some positive communication of this change, by the staff or by letter or by sign.

    I want to negotiate the price with him, since I bear responsibility but I think he bears some, too.

    What is your opinion of his culpability, professional, ethical or otherwise?

    I appreciate being able to ask this question.

    What is the name of your state (only U.S. law)? ILLINOIS
    You may not like my answer, but it is ultimately YOUR responsibility to ask whether the Physician is still in network with your insurance plan. The Physician is under no obligation to list the insurance plans he accepts.

    You can always try to talk to his office manager about the possibility of paying what BC would have paid if he were still in network, but there's no guarantee, and he is not obligated, to accept that amount as payment in full.

    How do you know he was dropped by the plan and just did not renew his contract?
  4. #4
    barry1817 is offline Senior Member
    Join Date
    Apr 2005
    Location
    Southern Ca.
    Posts
    1,100

    insurance payment

    Quote Originally Posted by OB Terry View Post
    I visited my dermatologist in December. I've been a patient of his for over ten years, but had not been there in well over a year (for dermatology, you don't have to). I've used the same insurance (Blue Cross/Blue Shield) for the entire time.

    Since it had been over a year, I had to fill out all the paperwork again, my health history, employer, and of course insurance. I gave them my card to copy at their request.

    Then I had some in-office minor surgery.

    Now I get the bill - for essentially the entire thing. What the doctor's front-office staff did not tell me, nor were there signs, nor did I get a letter, is that BC/BS dropped him in May 2010.

    So his services are considered out-of-network: I start an entire separate deductible, I pay the excess over everything the insurance didn't pay, etc, etc.

    OF COURSE I KNOW that I have to protect myself, but I am being told over and over again by interested friends and co-workers that there should have been some positive communication of this change, by the staff or by letter or by sign.

    I want to negotiate the price with him, since I bear responsibility but I think he bears some, too.

    What is your opinion of his culpability, professional, ethical or otherwise?

    I appreciate being able to ask this question.

    What is the name of your state (only U.S. law)? ILLINOIS
    For a long term patient, I find what this doctor did really nasty to you. He knew, or his office billing knew, that you were covered by insurance, which he dropped.

    He should have informed you, as is courtesy by many doctors that I know that do that, and my bet is that you would have been happy to stay with him and work with his fees.

    But to just assume that a long term patient, knows that he dropped the insurance coverage and didn't tell you is just plain wrong, especially since you were going in that day for a surgical procedure, and I am willing to bet, that the procedure was not an emergency, and could have waited until financials were explained.

    Wonder if you also signed an informed consent, and a financial disclosure before the treatment.
  5. #5
    OB Terry is offline Junior Member
    Join Date
    Jan 2011
    Posts
    4
    I was told by his billing office that BC/BS dropped HIM, I thought that was interesting. I don't know if it was just PPO In-Network, which is what I have.

    I know it was my responsibility, I said that already, but then why do hospitals post conspicuous signs in their waiting rooms about what insurances they now have or don't have, and why did my mother's regular doctor mail her a letter about his participation in her secondary coverage policy?

    My plan is to find out what the in-network cost would have been, and offer to split the difference with him, so that we each bear some cost. I'll be honest and point out that I am still satisfying a deductible and that will increase my share, deception gets me nowhere.

    But my other plan is to make sure I go on every darn website that allows people to rate doctors and make it clear that I have no problem medically with him, but a big problem with the professionalism of his staff. How hard would it have been to look at the BC/BS card they required I show them, and say "we no longer participate in the PPO Network?"
  6. #6
    cbg
    cbg is offline Senior Member
    Join Date
    Nov 2001
    Location
    Massachusetts
    Posts
    33,448
    IF (and obviously I do not know if this is the case) the doctor only dropped (or was dropped) from some, or one, of the networks, it would not be appropriate for the office to remove the sign indicating their participation. Since they WOULD still be participating, just not in the network you have.

    No one said it was a perfect system. That's why the patient still retains the ultimate responsibility for confirming that the doctor is not only participating, but participating in THEIR specific plan.
    Two things I am tired of typing: 1.) A wrongful termination does not mean that you were fired for something you didn't do; it means that you were fired for a reason prohibited by law. 2.) The above answer, whatever it is, assumes that no legally binding contract or CBA expressly says otherwise. If it does, the terms of the contract apply.
  7. #7
    OB Terry is offline Junior Member
    Join Date
    Jan 2011
    Posts
    4
    Sorry I wasn't clear enough: the office has NO signs at all, either indicating coverage or indicating cancellation of coverage.

    I wouldn't expect them to put up a sign saying "we take BC, Aetna, Joe's Insurance, etc." That would be changing and the list might be really long.

    I would expect them to do what other offices do: put up a memo or a sign that says "as of 05/01/10, we no longer are in the BC/BS Network."

    Or, even better, because maybe signs look ugly: how about when someone hands them a BCBS card they say "did you know the doctor is out of network?"
  8. #8
    lealea1005 is offline Senior Member
    Join Date
    Jul 2006
    Location
    supratentorial region
    Posts
    2,603
    Quote Originally Posted by OB Terry View Post
    Sorry I wasn't clear enough: the office has NO signs at all, either indicating coverage or indicating cancellation of coverage.

    I wouldn't expect them to put up a sign saying "we take BC, Aetna, Joe's Insurance, etc." That would be changing and the list might be really long.

    I would expect them to do what other offices do: put up a memo or a sign that says "as of 05/01/10, we no longer are in the BC/BS Network."

    Or, even better, because maybe signs look ugly: how about when someone hands them a BCBS card they say "did you know the doctor is out of network?"
    You're sure there wasn't an information sheet of some sort that was given to you after filling out the paperwork?

    As far as being dropped by BC....insurance companies drop Physicians for reasons that aren't that "interesting". A few years ago, in my area, a certain insurance company dropped Physicians who had very small practices/ patient bases on their plan. A few of the larger practices were kept on plan and the patients were directed to them.
  9. #9
    Indiana Filer is offline Senior Member
    Join Date
    Jan 2004
    Location
    IN
    Posts
    1,795
    Prior to going to the appointment with this doctor, did you check to make sure he was still in-network for your insurance? Every health insurance I have ever had has had a listing of in-network physicians. I can go on-line, look in the print version of the physician directory, look in the CD-rom version of the directory, or call the insurance customer service to verify if the health care provider is in or out of network.

    It's your responsibility to make sure he's in-network if you want your insurance to pay the benefits for her services. It doesn't matter that he was in-network in the past.

    Also, do you realize how many BC/BS policies there are? The policy benefits, and network directory, could depend on who your insurance is through, and which level of insurance you have. Is it basic, high, high deductible? Not every doctor takes every kind of insurance.

    Pay your bill, and next time, check the directory before you assume the health care provider is covered.
  10. #10
    dadda11o is offline Member
    Join Date
    Jan 2011
    Location
    Indiana
    Posts
    35
    My husband took our daughters to the dentist when we had no insurance. They applied sealants without checking with us first. He paid by credit card instead of speaking up. ($600). I complained later; they knocked several hundred off. I've also been able to negotiate better rates with medical providers by paying within a certain time frame; there are months we get a bill with discount offered for payment of outstanding charges that month. If you are a long time client, I'd explain it nicely and go to a higher level if need be...last time, they had to check with the doctor for authorization, but the bill was lopped. I've just gotten in the habit of getting pre-authorization ahead of time to prevent nasty surprises like that. I hope that helps.
  11. #11
    OB Terry is offline Junior Member
    Join Date
    Jan 2011
    Posts
    4

    Just to close the thread

    The doctor, working through the billing clerk, reduced my bill to about 25% of the total amount he was billing to BC/BS. I asked politely if there would be some adjustment, because although I should have asked whether anything had changed with insurance, after ten-plus years with him and BC/BS, I shouldn't have had a reason to suspect anything was going to change.

    He came down farther on the bill than I expected, and I was very relieved.
  12. #12
    fma
    fma is offline Junior Member
    Join Date
    Feb 2011
    Posts
    1
    OB Terry, I just found this thread after searching b/c the exact same thing happened to me. I believe we are talking about the same dr in IL. I am sick to my stomach b/c i received a 3500 bill i can't pay. i have bc bs ppo, and i have been a patient since 1999, so never thought i'd have to recheck my benefits! Any advice you can offer me on how to handle this situation?

Similar Threads

  1. Drs obligation to inform of suspected disease
    By LesSher in forum Medical and Health Care Malpractice
    Replies: 32
    Last Post: 02-09-2012, 02:26 PM
  2. Doctor Dropped Me
    By JenniSam in forum Medical and Health Care Malpractice
    Replies: 10
    Last Post: 09-29-2011, 11:09 AM
  3. Whos Obligation to pay childrens doctor bills
    By cedarrose24 in forum Marriage, Domestic Partnerships and Other Family Law Matters
    Replies: 5
    Last Post: 02-05-2010, 05:49 PM
  4. Who can a doctor inform of the results of your procedure?
    By meljane in forum Medical and Health Care Malpractice
    Replies: 3
    Last Post: 07-15-2008, 11:37 PM
  5. Sterility and Obligation by the Doctor.
    By Bleh565 in forum Child Support
    Replies: 11
    Last Post: 06-11-2008, 11:48 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  

© 1995-2012 Advice Company, All Rights Reserved

FreeAdvice® has been providing millions of consumers with outstanding advice, free, since 1995. While not a substitute for personal advice from a licensed professional, it is available AS IS, subject to our Disclaimer and Terms & Conditions Of Use.