Lied to about doctor being in network?

[unliable]

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

So I used a Providence health facility which is covered by my insurance and apparently almost all of the doctors are covered except the new ones? I asked the office if the doctor was an in network provider and was told yes and asked if it was just a 20$ copay they said yes.... A year later I look at my credit report and I see a debt of 85$ trying to be collected by them??? Never told of this and they had my number to call me. Is there any course of action I can take that will end with me not having to pay this bill and have it removed from my credit history?

 

[ecmst12]

You could ask very nicely. It's your responsibility to verify whether a doctor is in network with your insurance company. They do bear some responsibility for not billing you in a timely fashion though.

 

[cbg]

I just had to explain this to one of my employees earlier this week. Thankfully in his case it was a heads up so that he knows to ask.

As much as both the health insurance company, your employer, and the health care facility would like it to be otherwise, an individual doctor cannot be forced to participate in a health care plan if he doesn't want to. (Exceptions can exist based on the contracts between the doctors and the facilities - staff model HMO's, for example. But for the most part this is true. The doctor has freedom of choice.) The health insurance carrier would love it if they could, and so would the health care facility. If they could, it would eliminate this kind of problem. But in most cases the doctor has the right to say no, I don't want to be a participating provider under this plan. It also occasionally happens that a doctor, new in the facility, can still be in the application process and is not participating simply because the paperwork is still being done.

It's quite understandable that you might think that because a facility is in network that all doctors at that facility are, but that is simply not always the case. There are at least three specialities where the doctors are prone to feel that they have a "captive audience" as it were; radiology, anesthesiology, and emergency room doctors do not have private practices as a rule. Their patients are limited to the ones they are sent by the hospital - their practice is such that no one is going to come to them directly for care. So they may feel that they can earn as much, or more, by not being in-network provides. Doctors in other specialities may feel similarly for other reasons.

It's a shame that you were given incorrect information. I very much doubt it was a lie - a deliberate attempt at misleading you. I suspect it was instead a mistake "oops, we forgot that Doctor Jones is still in the credentialing phase". But either way, what you do now is contact your insurance carrier and see what they recommend, and also the billing office and see what they are willing to do to help you.

After you've done that, if you still have questions, come back here.