Bait-and-switch medical?

[cbg]

Health care is a bit of a mess in the US.

An understatement if I ever heard one.

 

[bcr229]

Health care is a bit of a mess in the US.

Actually I think that our health care is just fine in the US, but our health insurance is a mess.

 

[LdiJ]

Unless your insurance policy expressly and in so many words puts the responsibility on your doctor, it is YOUR responsibility and not that of the doctor to confirm who is and is not in network. The insurance company has already gone above and beyond what they are required to do. You can whine all you want about how inconvenienced you were but you have already received everything you are due under any legal process you could come up with, and more than you are due under some. If you feel that you absolutely must do something more, write a complaint. Maybe, if you annoy them sufficiently, they might give you some go-away money to shut you up. Probably not; they'll probably ignore you. But there's always the chance that someone might think it's worth while to make you feel all justified.

But next time, remember that it's not the doctor's job to confirm who is and is not in network - it's yours.

While that is absolutely true I have found it disappointing that doctor's often are unwilling to address insurance issues or cost issues. I do not have health insurance therefore I am very specific with doctors about the cost of things. I needed some outpatient surgery on something and shopped it. The doctor I selected charged me the exact amount quoted on the day of the surgery, but then two weeks later I got a bill for 3 times the original amount minus the amount I already paid.

Once confronted the doctor did cancel the bill but it took me confronting the doctor in writing rather than over the phone...and the doctor professed total ignorance of his office's billing practices.

 

[quincy]

While that is absolutely true I have found it disappointing that doctor's often are unwilling to address insurance issues or cost issues. I do not have health insurance therefore I am very specific with doctors about the cost of things. I needed some outpatient surgery on something and shopped it. The doctor I selected charged me the exact amount quoted on the day of the surgery, but then two weeks later I got a bill for 3 times the original amount minus the amount I already paid.

Once confronted the doctor did cancel the bill but it took me confronting the doctor in writing rather than over the phone...and the doctor professed total ignorance of his office's billing practices.

The doctors are experts in doctoring. They have office staff to handle the business side of their practices (appointments, billing, insurance).

I personally would much rather my doctor know medicine than insurance and which other doctors are in or out of network.

 

[LdiJ]

The doctors are experts in doctoring. They have office staff to handle the business side of their practices (appointments, billing, insurance).

I personally would much rather my doctor know medicine than insurance and which other doctors are in or out of network.

A doctor's office is a business. I think it's shameful that the head of any business cannot make business decisions that stick. The doctor I dealt with agreed. He had his staff give me a quote, and then his staff later decided to bill more than that quote. As the head of his business he cancelled the extra billing.

If a doctor cannot accurately say whether or not another doctor is in or out of network, then the doctor should say that. The fact that the doctor has staff that handles the business side of things is no excuse for giving inaccurate information to a patient.

 

[cbg]

There, you see, OP? Maybe someone like LdiJ will get your letter of complaint and decide that even though it wasn't the doctor's job to know who was in and out of network, they'll give you some money so you can feel all warm and fuzzy because you got paid to make the doctor do your job.

 

[Litigator22]

. . . remember that it's not the doctor's job to confirm who is and is not in network - it's yours.

In this particular instance it is of no consequence as to whether or not the OP was obligated "to confirm who is and is not in network"!

Read again the first sentence in the OP's initial posting and then please explain why the principal of promissory estoppel would not apply to defeat any action by the subject care provider to recover charges in excess of those contained in the OP's health insurance carrier's agreements with like providers.

 

[Taxing Matters]

the principal of promissory estoppel

That would be the principle of promissory estoppel.

In California, the elements of a claim of promissory estoppel are as follows:

“The elements of a promissory estoppel claim are ‘(1) a promise clear and unambiguous in its terms; (2) reliance by the party to whom the promise is made; (3) [the] reliance must be both reasonable and foreseeable; and (4) the party asserting the estoppel must be injured by his reliance.’ [Citation.]” (US Ecology, Inc. v. State of California (2005) 129 Cal.App.4th 887, 901, 28 Cal.Rptr.3d 894; see Kajima/Ray Wilson v. Los Angeles County Metropolitan Transportation Authority (2000) 23 Cal.4th 305, 310, 96 Cal.Rptr.2d 747, 1 P.3d 63.) “[T]o prevail on its promissory estoppel claim, [Flintco] was required to prove that it had reasonably relied on [TEC's] bid to its detriment, and that injustice could be avoided only by enforcing [TEC's] promise to perform at the quoted price.” (Diede Construction, Inc. v. Monterey Mechanical Co., supra, 125 Cal.App.4th at p. 386, 22 Cal.Rptr.3d 763.)​

​

Flintco Pac., Inc. v. TEC Mgmt. Consultants, Inc., 1 Cal. App. 5th 727, 734, 205 Cal. Rptr. 3d 21, 26 (2016). While it certainly might apply to the doctor here, I don't see it as a slam dunk. I think there well could be argument made that the OP did not reasonably rely on what the doctor told him about whether the other doctor was in network or not. After all, one would think to either directly ask that other doctor or the insurance company for that information as either of them would know better if that other doctor was in network. That, of course, would be up to the fact finder to determine. I express no opinion on how that turn out since I don't have all the details as to what was said, etc. I'm just saying that it's not clear cut either way, IMO, just based on what we have here.

 

[Rocko]

Re: "I think there well could be argument made that the OP did not reasonably rely on what the doctor told him about whether the other doctor was in network or not. After all, one would think to either directly ask that other doctor or the insurance company for that information as either of them would know better if that other doctor was in network."

The managing doctor -- a part owner in this doctor owned in-network facility -- promised me his subordinate was in-network. Is it not material that he is part owner and thus directly profits from his promises? What stops him from making false, reckless and cavalier promises with the onus then being transferred to the damaged patient?

 

[Just Blue]

The managing doctor -- a part owner in this doctor owned in-network facility -- promised me his subordinate was in-network. Is it not material that he is part owner and thus directly profits from his promises? What stops him from making false, reckless and cavalier promises with the onus then being transferred to the damaged patient?

What is it your after? If its money, you aren't going to get it. If you want him to be "punished" in some way file a complaint.

 

[quincy]

The managing doctor -- a part owner in this doctor owned in-network facility -- promised me his subordinate was in-network. Is it not material that he is part owner and thus directly profits from his promises? What stops him from making false, reckless and cavalier promises with the onus then being transferred to the damaged patient?

What stops most doctors in California from making “false, reckless and cavalier promises?” The Medical Board of California.

You ultimately suffered no injury. You were simply inconvenienced.

In the future, perhaps both the doctor and you will be more careful - the doctor in making statements he cannot support and you in believing everything you hear.

Good luck.