Why am I being forced to pay for these doctors visits?

  • by Sarah
  • Dec 05,2017
  • 9 answers

So long story short, I begin to see a doctor whom I at the time believed was within my insurance network i continue to visit this doctor for about 6 months (1 appointment every month to check up on med dosage) without being billed once (so i assume insurance is doing their job and making the payments necessary). After seeing this doctor for 6 months they refer me to a psychiatrist within the same hospital to diagnose me officially with ADHD so I can start treatment. I continue to see the original doctor for another 6 months (one appointment per month). After seeing a doctor at this hospital for an entire YEAR I get my first bill from them. It is $1974. I call the hospital to ask why I received this bill and they told me that insurance rejected the claim because the doctor was not in the network . This opened the floodgates. After going back and forth with my insurance company and the hospital I find out that I owe over $5000 in unpaid medical bills for the entire year of treatment. Neither the hospital nor the insurance company want to take any fault in failing to notifying me within a timely manner that these bills were outstanding. Mind you, insurance gladly covered all the medications that I had been picking up. My question is: Is there anything anywhere that relieves me of these payments?! I obviously would not have gone to see a doctor for an entire year knowing that I would have to pay out of pocket. Any information, resources or advice is greatly appreciated!!


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Insurance Answers (9)

alyssa last month

Isk

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StephenWeinstein last month

1. Because you saw the doctor. That's not free, and you have to pay for it, unless someone else does.
2. Because you assumed that insurance doing YOUR job and making the payments necessary. Making sure that the doctor gets made on time is your job, not theirs.
3. It is not that they don't "want" to take any responsibility. It's that they can't, because that would be too dishonest, even for them. They are not responsible for notifying you. You, and only you, are responsible for checking on whether the bills have been paid on time.

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curtisports2 last month

It is ALWAYS up to you to check with your insurance company BEFORE treatment to see if the providers are in-network. This could have been prevented.

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Judy last month

Sorry, but no, you're stuck with the bills

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Insurance Pickle.com last month

Unfortunately, it's just a very expensive lesson. The medications are covered because clearly you filled those prescriptions in the right place. But, it's ultimately your responsibility to make sure you understand not only the process of seeing doctors, but to make sure they're in network providers. You never assume anything. Every time you see a doctor, you should be receiving an Explanation of Benefits (EOB) in the mail. If you don't, then you should start calling to find out why. Because, it's the EOB from the insurance company that you ultimately match up with the doctors' bills to make sure they're correct before paying.
Sorry again, but that's on you for not asking the proper questions and assuming. Your best bet is to ask for a discount and payment plan.

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Casey Y last month

Sorry, but its not their fault.
"(so i assume insurance is doing their job and making the payments necessary). "
Why assume???

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Michael last month

Because the first time you went to both of those doctors you were notified in writing that you are responsible for the full cost of all visits should your insurance company not pay. It was likely buried in a pile of paperwork you were asked to fill out and sign. Whether or not you actually bothered to read it isn't anyone's problem but yours.

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H. Marie last month

that is a problem if you don't inquire first about the doctor accepting insurance
with the ACA it is possible that more and more doctors will not accept certain insurance payments, there was a time that doctors accepting Medicare were rare and this might return if doctors don't feel they can afford to practice at the rate approved

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lucy last month

Your doctor could have or not been in network. Every year and sometimes in mid year, insurance companies and doctors/providers can (change) to be in network or not. To be in network means that your insurance and the doctor (agrees) on how much they can charge for the services they charge and bill for.
If an doctor/provider is out of network, then they (don’t) agree on how much (your) insurance (believes) is owed or billed, thus can get hit with some big bills.
The most common time this happens is when you have surgery. Prior to the surgery you could verify with your insurance that the surgeon and the hospital is in network, so you don’t worry about it, till you get bills from the radiologist or the anesthesiologist, (who) usually have no clue who they are and many times assigned when you have the surgery, thus not aware that they are (not) in network, thus get hit with this big bill. Now that is one of those instances that you can fight or appeal it, since with the surgeon and the hospital being in network, that you (expected) all others in the surgery to be in network.
The problem is that when you see a doctor or provider, they ask for your insurance, and they (also) have you sign a form that states “if my insurance does not cover, then (I) agree to be held personally responsible for the costs”. They don’t care if your insurance is in network or not, since it is (not) their job to so, but only to bill them for the services, and what insurance does not pay, then YOU will be billed for that amount, since again, you signed that form, I am guessing (every) time you went to each doctor and did not think a thing about it.
So just because this doctor referred you to this phychiatrist that was in this same hospital does (not) mean they are in network or out of network, since your doctor is not required o check this out, YOU are. If you have called your insurance and asked them, then they could have told you that the psychiatrist was not in network, and then you could have asked them (what) phychiatrists are?.
Now during this year since having monthly visits, you should have received an EOB, which would have shown that that the insurance did not cover and would have a note that the doctor or phychiatrist was (not) in network and also to the right of the EOB, would state that they will bill you this amount that YOU would owe.
No one is going to believe that for (1) year, 12 visits for your doctor and 6 for the physiatrist, you did not get (any) EOB’S, nor did you get any bills. Most health insurance sites have a place to look at all the claims submitted on your behalf, and you should be able to go there to access those bills.
So my suggestion to you is to call them and ask for a discount and also pay on a payment plan. Then from this day forward, I suggest to (prior) to seeing any doctor, you call your insurance 1st and ask them, are they in network or not.

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