DR. said he was in plan, but not really

[kimpappa]

I went to a chiropractor who told me on several occasions he was in my network. I started to get statments from my insurance company applying my visits to a deductable, that I would only have if I saw a out of network Dr. I called the Dr. and again he told me that he was in the network. 5 months later I get a final notice saying I owe over $600 dollars, that my insurance did not pay. This was the first time I received anything from the Dr.saying that there was a blance due. I called my insurance company and I was told that the Dr. was not in my network, and that they paid out of network. They Dr. said that he verified benefits, and that it was standard procedure to verify benefits before starting treatment. Now he is saying that I need to pay the balance. I feel I was grossly misled. I never would have begun treatment with a Dr. out of network. I have copies of my account history and the patient balance column says 0, it says I have a zero deductable and my portion was 10%. Am I responsible for the $600? I aslo received a statement amonth after the final notice with patient responsiblilty 0, and insurance responsibilty $600.

 

[Krystalbubbles]

HMO?

If this is under an HMO plan you may be able to get a retro-active referral from your primary care physician to cover the dates of service. You may also want to call the insurance company again to ask if the doctor had in fact called them prior to the first treatment. They can tell you if he did call and the basics of what was said to him, such as if HIS services would be covered. If he just asked if the service was covered and got the response of 'yes' then there would be a problem within the doctors office. They should have asked if the services rendered by him would be covered. Many times under an HMO plan the member needs to get a referral from the PCP (primary care physician) in order to go to any other doctor regardless of treatment (with the exception of a dentist unless it's medically related). Just a helpful hint in the future, before you go to any other doctors besides your PCP, ask to get a referral so there won't be any hassles from the insurance company about the claim.

Bubbles ())