In-Network doctor charges upfront and says he doesn't accept insurance

[ajkroy]

Since when does a provider have a right to ignore their contract with bcbs?

Exactly. OP's redress is with BCBS; they don't take kindly to doctors on their plan circumventing their contracts.

However, the insurance will likely just drop the provider. It will make certain no other BCBS patients find themselves in the same position, but it doesn't help OP.

 

[Nokin]

Insurance might drop him so he would not scam other members of the same insurance and yes, then he has no reason to pay me anything. My only hope is that there is some incentive or benefit for him to be a preferred provider within Bcbs and that he would like to keep that status.

 

[cbg]

Whether or not that is the case will depends on a lot of factors.

 

[Nokin]

UPDATE! This got resolved already in late December last year. After pressure from the insurance company the doctor finally did pay the difference that he owed us. I also learned that BcBs had the same type of a claim against the same doctor from another member. I also had a private conversation with a family friend who is a physician of a different field but is in network with our insurance and they confirmed that the contract between insurance company and a doctor does not allow the doctor to draw up a different contract with a member of that insurance company.

 

[Taxing Matters]

UPDATE! This got resolved already in late December last year. After pressure from the insurance company the doctor finally did pay the difference that he owed us. I also learned that BcBs had the same type of a claim against the same doctor from another member. I also had a private conversation with a family friend who is a physician of a different field but is in network with our insurance and they confirmed that the contract between insurance company and a doctor does not allow the doctor to draw up a different contract with a member of that insurance company.

Thanks for coming back with an update on how it turned out. Not many people do that. Good to hear you got it resolved in your favor.

 

[PayrollHRGuy]

I'd like to echo TM's thanks. I'll bet this doctor has had some pretty serious conversations with BCBS.

 

[xylene]

I'm glad you got satisfaction for you shabby treatment by the doctor and the insurer.