Bait-and-switch medical?

[Rocko]

What is the name of your state? California

A managing doctor verbally promised me his subordinate who treated me was in-network. Turns out he was not and I received a surprise medical bill for five times the in-network amount and also containing misdiagnoses / upcodings. It took me a good amount of time to get them to remove their misdiagnoses from my bill and from my medical record. So too did it take me a good amount of time to get the insurance company to admit it was slow in removing the doctor's name from its website. It ultimately paid ME the full out-of-network amount to reimburse the doctor. First question: is this bait-and-switch, being that the doctor promised me he was in-network? Second question: am I due any consideration of my expertise, time and efforts in fixing my bill and medical record? How would you suggest I proceed? Thank you for your valued time and expertise.

 

[quincy]

What is the name of your state? California

A managing doctor verbally promised me his subordinate who treated me was in-network. Turns out he was not and I received a surprise medical bill for five times the in-network amount and also containing misdiagnoses / upcodings. It took me a good amount of time to get them to remove their misdiagnoses from my bill and from my medical record. So too did it take me a good amount of time to get the insurance company to admit it was slow in removing the doctor's name from its website. It ultimately paid ME the full out-of-network amount to reimburse the doctor. First question: is this bait-and-switch, being that the doctor promised me he was in-network? Second question: am I due any consideration of my expertise, time and efforts in fixing my bill and medical record? How would you suggest I proceed? Thank you for your valued time and expertise.

Your efforts were already rewarded. You are not compensated monetarily for the time you spent. I see no bait-and-switch.

In the future, I recommend you check with your own insurer directly and do not rely on what you are told by the doctor or doctor’s office.

 

[Just Blue]

What is the name of your state? California

A managing doctor verbally promised me his subordinate who treated me was in-network. Turns out he was not and I received a surprise medical bill for five times the in-network amount and also containing misdiagnoses / upcodings. It took me a good amount of time to get them to remove their misdiagnoses from my bill and from my medical record. So too did it take me a good amount of time to get the insurance company to admit it was slow in removing the doctor's name from its website. It ultimately paid ME the full out-of-network amount to reimburse the doctor. First question: is this bait-and-switch, being that the doctor promised me he was in-network? Second question: am I due any consideration of my expertise, time and efforts in fixing my bill and medical record? How would you suggest I proceed? Thank you for your valued time and expertise.

1. No.

2. No...such inconveniences are a part of life and we don't (usually) get paid for it.

3. Go forth and be glad the situation was resolved.

 

[Taxing Matters]

First question: is this bait-and-switch, being that the doctor promised me he was in-network?

No. Bait and switch is a tactic in which a seller advertises a product for sale that it has no intention of actually selling (the bait) in order to get you in the door, and then once you get in the door it steers you to another product that it the one it really wants to sell you (the switch).

Here, it appears the doctor to whom you spoke believed the other doctor was in-network, perhaps by checking the insurance company itself (whether through the website or otherwise) and, as you said, the insurance company didn't have it's information updated to show he/she was no longer in-network. Thus, that fault lies with the insurance company.

Second question: am I due any consideration of my expertise, time and efforts in fixing my bill and medical record? How would you suggest I proceed? Thank you for your valued time and expertise.

Legally, no. The time you spend resolving billing and customer service issues with any business, including an insurance company, are not compensable. Ultimately the insurance company here corrected the problem and you ended up getting what was promised to you, and that's all it had to do. As frustrating as dealing with problems like this is — and we've all been there at some point with some company — the time and frustration in getting these kinds of things resolved doesn't entitle us to extra money. If it did, the prices of goods and services would go up to cover what the companies would have to pay out. In the end, I think we'd all lose more than we'd gain out of that.

 

[Rocko]

The fact that there was a "surprise medical bill" AND "upcoding" sticks in my craw. The managing doctor promised me that his subordinate was in-network AT THE TIME OF SERVICE. So even if the insurance company accepted responsibility and paid because its website was slow in removing him, the fact that the doctor was promised as being in network at the time of service means that he should receive the in-network reimbursement amount. They should not profit from "upcodings" nor from a loophole they found by taking advantage of the insurance company's slow process of updating their website listing.

 

[Just Blue]

The fact that there was a "surprise medical bill" AND "upcoding" sticks in my craw. The managing doctor promised me that his subordinate was in-network AT THE TIME OF SERVICE. So even if the insurance company accepted responsibility and paid because its website was slow in removing him, the fact that the doctor was promised as being in network at the time of service means that he should receive the in-network reimbursement amount. They should not profit from "upcodings" nor from a loophole they found by taking advantage of the insurance company's slow process of updating their website listing.

Again, this is just one of those unpleasant life chores that most adults deal with at one time or another. Put it behind you and move on.

 

[Rocko]

Imagine a managing doctor confirms which subordinate is covered by the patient's insurance and then assigns said subordinate to perform what's prescribed. If the insurance is slow in removing or fails to remove said subordinate, who's at fault and who's ripe for exploitation -- being that we the insured ultimatly pay with increased premiums and insurance companies profit from said increases? Might we be being taken advantage of from both ends?

 

[quincy]

Imagine a managing doctor confirms which subordinate is covered by the patient's insurance and then assigns said subordinate to perform what's prescribed. If the insurance is slow in removing or fails to remove said subordinate, who's at fault and who's ripe for exploitation -- being that we the insured ultimatly pay with increased premiums and insurance companies profit from said increases?

Your medical billing dispute was resolved in your favor. There is nothing for you to do from a legal standpoint.

But if it makes you feel better, you can send letters of complaint to all involved.

 

[adjusterjack]

How would you suggest I proceed?

Get over it.

 

[Zigner]

Seems to me that the actual doctor never said he was in-network...

 

[cbg]

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.

 

[eerelations]

har

 

[quincy]

har

As in “har har har?”

 

[eerelations]

As in “har har har?”

As in this couldn't possibly happen in Canada - really, couldn't happen at all, not ever, not in any part of Canada - so yes, har har har. Sorry.

 

[quincy]

As in this couldn't possibly happen in Canada - really, couldn't happen at all, not ever, not in any part of Canada - so yes, har har har. Sorry.

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