ins. won't pay Dr. visit

[kay1330]

What is the name of your state? Michigan I had health ins. through my husbands employer with Alliance health and life for a couple months before they switched to another provider. During this time I needed to go to my Dr. once, I called Alliance to verify that he was in network, they said I had to call this other number which I did, they said no call alliance, so I did. I did ask for them to send me the book of in network Doctors at that time. By the time I was done calling they had verified that he was in network.
So I went to my doctor. I went on 10/16/03, I just now have received a bill saying Alliance denied due to non network Dr.
I have the book with his name in it, they now tell me that they did not send this book to me and they won't pay. I paid my premiums on time($140.00 a week), and they won't pay $37.00.
I know it's only 37.00. but I should not have to pay this. What can I do?

 

[Beth3]

It's frustrating for all concerned trying to keep up with which medical providers are in-network because as soon as the PPO or insurance carrier publishes that information, it's out of date. In-network provider lists are in a constant state of flux. I appreciate you did your very best attempting to verify this doctor was in-network but the truth is, if at the time you saw this doctor he was not in the discounted network, there are no savings for the insurance carrier to pass on to you.

What you (or your husband) should do is to contact the individual at his employer's who handles employee benefits and let them call the carrier and try to sort this out for you. They should know who to contact at a level or two above the customer service people you've been dealing with and cut through some of the bureaucracy. I can't gurantee a favorable answer but they should be able to get you a straight answer.

P.S. Next time you want to know for sure, ask the doctor's office to verify that they're still in-network when you go for your appointment.