Do we have reason to complain?

[rin]

My DH's doctor suddenly stopped taking our insurance, but didn't tell us when he was there for his last appointment to get his prescription refilled. Would it be reasonable for us to request that they only bill us the amount that our copay would have been, or do we just pay up and change doctors?

If we had known they had stopped taking his insurance, he would have switched doctors and would not have gone in for the prescription refill appointment.

Totally irritated, but not sure if I should just take a deep breath and let it go . . .

TIA!

[BunnyBee]

Can you file the insurance yourself? They definitely should have let you know! Ours asks about insurance changes at check-in. Did you pay a co-pay?

[mytwosons]

I think that is totally reasonable. They really should have notified you when they stopped accepting your insurance.

[TwoBees]

I think that is totally reasonable. They really should have notified you when they stopped accepting your insurance.

:yeahthat:

[sunshine873]

I think that is totally reasonable. They really should have notified you when they stopped accepting your insurance.

:yeahthat:

[rin]

Thanks ladies. Calling now to ask them to adjust the bill.

[lalasmama]

I have worked in medical clinics for 17 years now....

I would recommend calling the office manager. I wouldn't complain, per se, but just say, "Dr Smith has taken our x insurance for x years. My husband had a recent visit, and the front desk didn't let us know that he'd stopped taking our insurance. In fact, we received no notification until we got a bill for $x. Since we weren't alerted of this change, I'd like to see if we could come up with a compromised price."

Just wondering--did they take a copay or coinsurance the day of his appointment?

[Snow mom]

If the doctor is no longer accepting the insurance they should have notified you at the appointment or before. I would expect them to make it right somehow. I know our pediatrician no longer accepts patients with our insurance but does still process claims for current patients.

If your insurance no longer covers the provider they should send you a letter before the change.

[BabbyO]

not trying to be the devils advocate here, but I just thought I'd let you know that according to my insurance it is OUR responsibility to determine if the provider is in network at each and every appt. We had a little debacle with the ER a few months ago. I KNOW that the clinic/hospital/ER facility that we took Peanut to is in our network, but we were almost billed for the full bill because one of the ER docs - the one that saw Peanut - was not in our network. Talk about confusing....

I called our insurance and they told me it was my job to find that out and that the ER should have that info. Frankly...when I go to the ER I probably don't have the time to figure out if the specific doctor my child is seeing is in network. I assumed they all would be since the facility is in network.

In the end, because it was a contracted ER doc, and the facility was in network we weren't billed...but it was crazy and confusing and a giant headache. What I got out of it was that neither the hospital nor our insurance company would tell me if they were in network. Each said the other needed to inform me. When I looked up the doc and facility on the INSURANCE co network provider page both were listed as being in network...but there was something about contract negotiations, etc an the online tool not necessarily being up to date...and the insurance company kept telling me it was my responsibility to find out...

[egoldber]

In the end, because it was a contracted ER doc, and the facility was in network we weren't billed...but it was crazy and confusing and a giant headache.

We had this issue with younger DD's NICU bill. The hospital was in network, but we never thought to check that the NICU doc group was in network! You just assume, especially since you have ZERO choice about the docs you will see if your child is in the NICU!!!

[scrooks]

We had this issue with younger DD's NICU bill. The hospital was in network, but we never thought to check that the NICU doc group was in network! You just assume, especially since you have ZERO choice about the docs you will see if your child is in the NICU!!!

Not as quite as big of a deal as the nicu or the ER but the anesteiologist for my deliveries have ended up out of network. It's an in network hospital and you don't get to pick who they send! With dd it wasn't like as I was screaming for my epidural I could quiz them or call the insurance co!

[craftysierra]

Not as quite as big of a deal as the nicu or the ER but the anesteiologist for my deliveries have ended up out of network. It's an in network hospital and you don't get to pick who they send! With dd it wasn't like as I was screaming for my epidural I could quiz them or call the insurance co!

Same experience here and after a lot of back and forth they paid....

Sierra

[Sweetsunshine]

Wow that's nuts! I've never heard of such a thing.

[ShanaMama]

not trying to be the devils advocate here, but I just thought I'd let you know that according to my insurance it is OUR responsibility to determine if the provider is in network at each and every appt. We had a little debacle with the ER a few months ago. I KNOW that the clinic/hospital/ER facility that we took Peanut to is in our network, but we were almost billed for the full bill because one of the ER docs - the one that saw Peanut - was not in our network. Talk about confusing....

I called our insurance and they told me it was my job to find that out and that the ER should have that info. Frankly...when I go to the ER I probably don't have the time to figure out if the specific doctor my child is seeing is in network. I assumed they all would be since the facility is in network.

In the end, because it was a contracted ER doc, and the facility was in network we weren't billed...but it was crazy and confusing and a giant headache. What I got out of it was that neither the hospital nor our insurance company would tell me if they were in network. Each said the other needed to inform me. When I looked up the doc and facility on the INSURANCE co network provider page both were listed as being in network...but there was something about contract negotiations, etc an the online tool not necessarily being up to date...and the insurance company kept telling me it was my responsibility to find out...
We had a similar situation. I believe my insurance would cover even for out of network because it was an emergency. Something like that.
OP, the drs office should definitely have informed you. I'd ask them to adjust the bill.

[georgiegirl]

I would definitely ask them to adjust. I don't think it's the patients responsibility to continually check to see if a doctor who has always accepted their insurance does at every single visit. Their billing manager should have sent out notices when the practice decided not to accept that insurance anymore.

I've had issues since my insurance came up with a new category of in-network preferred, other in-network, and out of network. Of course I didn't find this out until I was 12 weeks along and already had 2 OB appointments with "other in-network," which had a 70/30 co-insurance v. 90/10 co- insurance. Then it took me over an hour on the phone with the insurance company before the could tell me which OBs were in-network preferred.

[westwoodmom04]

I would definitely ask them to adjust as well, but if they refuse, you don't really have any choice but to pay. Doctor's offices always have you sign a form at your first visit in which you agree to be ""personally responsible" for whatever insurance refuses/declines to pay.

[cookiemonster80]

We had this issue with younger DD's NICU bill. The hospital was in network, but we never thought to check that the NICU doc group was in network! You just assume, especially since you have ZERO choice about the docs you will see if your child is in the NICU!!!

It's a little known fact of most health plans that if you do not have a choice of an in network provider- example- any provider seen through an ER (doc, radiologist, etc) that you will only be charged under the in network parameters.

[JBaxter]

not trying to be the devils advocate here, but I just thought I'd let you know that according to my insurance it is OUR responsibility to determine if the provider is in network at each and every appt. We had a little debacle with the ER a few months ago. I KNOW that the clinic/hospital/ER facility that we took Peanut to is in our network, but we were almost billed for the full bill because one of the ER docs - the one that saw Peanut - was not in our network. Talk about confusing....

I called our insurance and they told me it was my job to find that out and that the ER should have that info. Frankly...when I go to the ER I probably don't have the time to figure out if the specific doctor my child is seeing is in network. I assumed they all would be since the facility is in network.

In the end, because it was a contracted ER doc, and the facility was in network we weren't billed...but it was crazy and confusing and a giant headache. What I got out of it was that neither the hospital nor our insurance company would tell me if they were in network. Each said the other needed to inform me. When I looked up the doc and facility on the INSURANCE co network provider page both were listed as being in network...but there was something about contract negotiations, etc an the online tool not necessarily being up to date...and the insurance company kept telling me it was my responsibility to find out...

OMG us too. I had a (then) 20 month old with a busted chin the ONLY hospital in town with out driving 40 min at 8pm the night before we left for Dominican Republic. Yeah how was I supposed to know the hospital he was born at and was provider didnt staff ER docs that was in network...

[Twin Mom]

I would definitely ask them to adjust. I don't think it's the patients responsibility to continually check to see if a doctor who has always accepted their insurance does at every single visit. Their billing manager should have sent out notices when the practice decided not to accept that insurance anymore.

Definitely ask them to adjust b/c it would have been nice if they told you but I work in employee benefits and it is the patient's responsibility to make sure the doctor is still in the network. You should ask before every appointment to make sure nothing has changed. That way you don't have situations like this come up. Yes it would be a natural assumption to believe the doctor was still in network but IMO it's better to be safe than sorry and check.

I am not talking about ER visits or inpatient hospital stays where you don't get a choice in physicians but regular visits to your usual doctors. I always ask when I make my appointments.

[Liziz]

I have worked in medical clinics for 17 years now....

I would recommend calling the office manager. I wouldn't complain, per se, but just say, "Dr Smith has taken our x insurance for x years. My husband had a recent visit, and the front desk didn't let us know that he'd stopped taking our insurance. In fact, we received no notification until we got a bill for $x. Since we weren't alerted of this change, I'd like to see if we could come up with a compromised price."

Just wondering--did they take a copay or coinsurance the day of his appointment?


not trying to be the devils advocate here, but I just thought I'd let you know that according to my insurance it is OUR responsibility to determine if the provider is in network at each and every appt. We had a little debacle with the ER a few months ago. I KNOW that the clinic/hospital/ER facility that we took Peanut to is in our network, but we were almost billed for the full bill because one of the ER docs - the one that saw Peanut - was not in our network. Talk about confusing....

I called our insurance and they told me it was my job to find that out and that the ER should have that info. Frankly...when I go to the ER I probably don't have the time to figure out if the specific doctor my child is seeing is in network. I assumed they all would be since the facility is in network.

In the end, because it was a contracted ER doc, and the facility was in network we weren't billed...but it was crazy and confusing and a giant headache. What I got out of it was that neither the hospital nor our insurance company would tell me if they were in network. Each said the other needed to inform me. When I looked up the doc and facility on the INSURANCE co network provider page both were listed as being in network...but there was something about contract negotiations, etc an the online tool not necessarily being up to date...and the insurance company kept telling me it was my responsibility to find out...

I agree with both of these. Mimi's approach is what I'd recommend too....because BabbyO is correct that at the end of the day, technically, it's your responsibility to know (frustrating, I know, but true). However, I think the office *should* have contacted you in advance -- or at least let you know when you checked in -- not because they technically have to but because it's the right thing to do. I think there's a good chance that someone was supposed to do that, and didn't/forgot for you -- which is why the office manager may be willing to work with you if you approach him/her politely and without making it seem like the practice was trying to cheat you/is out to get you/etc. (not that you'd do that to begin with, but as the person who often gets these sort of phone calls in my office, you'd be amazed what people accuse you of...)

[egoldber]

but regular visits to your usual doctors. I always ask when I make my appointments.

I ask at initial appointments, but it really would never occur to me to ask a doctor that we had been to previously that they no longer participate with our insurance. The doctors we see will typically put a sign up saying something like "as of X date we will no longer participate with Y insurance plan".


It's a little known fact of most health plans that if you do not have a choice of an in network provider- example- any provider seen through an ER (doc, radiologist, etc) that you will only be charged under the in network parameters.

And we protested and they did eventually pay. But it took almost a YEAR, we had to get the VP of HR at DH's company involved, and we got sent to collections. Nice.

[redstone]

My sister had a similar experience for a planned wrist surgery. She had carefully verified all the docs were in network before the surgery date. As she was getting the anesthesia, another doc came in and said he was stepping in because the other doc got called away on an emergency.

She was half drugged and, of course, didn't ask if the new guy was in her network. Sure enough he wasn't. It took months to finally get the bill straightened out. The insurance eventually covered the replacement doc, but what a major headache!

[TwinFoxes]

We had this issue with younger DD's NICU bill. The hospital was in network, but we never thought to check that the NICU doc group was in network! You just assume, especially since you have ZERO choice about the docs you will see if your child is in the NICU!!!

Apparently this is an ongoing problem at that hospital. Pretty regularly a new mom in my moms of multiples group posts about that issue.