doctors visiting charges

[Puja]

What is the name of your state (only U.S. law)? Illinois

i visited a doctor who claimed to be taking patients having the insurance plan that i have. He asked me to pay only the co-pay as required by my plan. After a month i have received a letter from the doctor asking me to pay the rest of the amount as the insurance company has refused to pay him.

When i contacted the insurance company, i have been told that the doctor is not one of the in network doctor and hence the they would not pay.

What should i do?

 

[ecmst12]

Pay for the services you received, and next time ask your INSURANCE COMPANY whether the doctor is in network - and BEFORE you see him rather then after. Doctors do not always know. He could participate with some plans from your company and not others. It's always best to check with the insurance company to know for sure.

 

[Puja]

I had got the name of the doctor from the website of the insurance company only and then made the doctor's appointment, but now his name is no longer appearing on their list.

 

[cbg]

Unfortunately, as contracts end or are renegotiated, it does happen occasionally that a doctor might drop off the in-network list, and the doctor's office has no way of keeping track of which patients are on which plans without checking every chart individually.

You are free to appeal the decision with the insurance company on the basis that the doctor showed as in-network on their website, but if you lose the appeal it will still be your responsibilty to pay the doctor.

 

[ecmst12]

If this was a recent change, I think you have a decent chance of getting your insurance company to cover it as a one-time thing. Call them.