misleading info from my health provider.

[mingdurga]

My provider gave me misleading info on my selection of a primary physician.
Was told he was in network; office personnel said the same thing. After 2 visits over a 3 month period, I just found out that the doctor is in network but the office he works out of is not (he has 3 different locations; I chose one closest to my home). They are billing me for over $200 when my co-pay for ea. visit is only $15. They are threatening to turn this over to a collection agency which will increase monies owed even more. I complained to my provider in Albany, NY and to doctor's acct. dept. with no results.
I'm not paying these bills since both parties were called in advance to confirm and nobody mentioned location as a financial consideration. NY State providers website doesn't even mention the location differencial.
What are my options if I use a lawyer to sue both parties for monies and legal fees?

Mike

 

[ecmst12]

You can't sue anyone for this.

You can pick a new PCP who is truly in network, and then you can discuss the mixup with your insurance company and ask that they cover the difference since they had told you this doctor was in network. They shouldn't have a problem with that.

 

[barry1817]

medical

My provider gave me misleading info on my selection of a primary physician.
Was told he was in network; office personnel said the same thing. After 2 visits over a 3 month period, I just found out that the doctor is in network but the office he works out of is not (he has 3 different locations; I chose one closest to my home). They are billing me for over $200 when my co-pay for ea. visit is only $15. They are threatening to turn this over to a collection agency which will increase monies owed even more. I complained to my provider in Albany, NY and to doctor's acct. dept. with no results.
I'm not paying these bills since both parties were called in advance to confirm and nobody mentioned location as a financial consideration. NY State providers website doesn't even mention the location differencial.
What are my options if I use a lawyer to sue both parties for monies and legal fees?

Mike

Definitely should be speaking to your insurance carrier, and having this looked into. If a doctor holds himself out to be in a network of providers there is an obligation when billing to bill according to the contract that he has agreed to.

The failure to do so could be a reason to void his provider account and that would cost him more than the problem that he is having with you.

 

[ecmst12]

The doctor is an employee of the office and likely has no control over billing at any of the locations. The GROUP is in charge of billing and contracting.

 

[lealea1005]

Definitely should be speaking to your insurance carrier, and having this looked into. If a doctor holds himself out to be in a network of providers there is an obligation when billing to bill according to the contract that he has agreed to.

The failure to do so could be a reason to void his provider account and that would cost him more than the problem that he is having with you.

In some states it is illegal to require a network Physician to contract with all products (ex: may contract with PPO & POS, and not HMO).