Does the doctor's office have to tell the specialist office the plan of insurance impatient has?

  • by thumper
  • Jan 11,2018
  • 12 answers

I asked because I found a doctor on my insurance company's website that was accepting my insurance for my asthma and I got my family doctor to send over a referral well the next day the pulmonologist office called me and set up an appointment with me I don't remember much about the phone conversation so when I get down there last Friday for my appointment they take my insurance card and say we don't take your insurance I was like really? They said yes it's true we do not take care insurance they said when your doctor's office called us they told us you have such and such for your health insurance but they never told us the exact plan you have and we accept the regular insurance through this company but we do not accept your plan which is medical assistance. He was like when the doctor's office called she was like they said that you had United Healthcare but they never told us you had United Healthcare Community Plan which is medical assistance so she blamed it on my doctor's office for not telling her the exact plan that I have. Call me nutty if you want but I thought that when my doctor's office called to get the referral that they had to tell them not only the insurance company I was through but also tell them the plan that I have through the insurance company which means I thought my doctor's office would say the patient has United Healthcare Community Plan I I think the wrong doctor's office was lying to me but I'm not sure. What should I think here


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Insurance Answers (12)

Judy 6 months ago

Yoou keep asking the same question, but the qnswer isn't going to change. They often do verify it, but aren't required to. Sorry you were inconvenienced, but there's nothing you can do about it.

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Casey Y 6 months ago

You've been posting the same question since Monday, just changing the facts slightly each time. Its still the same answer and we all feel bad that you had to go all the way there on your crutches riding the bus...but that has nothing to do with the answer to your question.
You also were not an impatient if you were not admitted to the hospital. That's called an outpatient.

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Greg 6 months ago

Obviously it is best if they do but sometimes there are issues. You could have checked with your insurance company before going. Insurance is a mess.

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Eva 6 months ago

Actually you are the one that selected the doctor. You didn't use the website properly to check if the doctor took your plan. Your gp's office assumed you had checked this all out since you requested that particular specialist. Not your family doctor's staff's fault.

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y 6 months ago

nope, hey don't, seems crazy. My wife was hospitalized this past summer. Need her Gallbladder removed, supposedly an emergency. But they didn't have a doc on schedule for two days that was capable of this surgery, tow days in the hospital waiting isn't cheap. But that isn't even the worse, part. The doc could only do part of the surgery, for some reason the doc that could complete it wouldn't be in for another week. So he dd his part, then they looked around at other hospitals to complete it. Ambulance ride to the other, ride back, none of it covered by insurance. The anesthesiologist used was also not covered by our insurance company. So all of sudden, we are getting billed for full price from these services that the hospital, who obviously had our insurance, scheduled out.

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Steven S 6 months ago

Providing the insurance info. is up to you.

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Who 6 months ago

ok - you are nutty

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lucy 6 months ago

Most doctors have (no) clue what insurance you have, since their concern is to treat you. But the billing people that work for the doctor, would know (which) insurance that they accept, since the billing people bill the insurance, and insurance then pays the doctor.
The problem is that many times doctor and specialists can change (who) they accept or not at any time.
Now in your case could have gone a couple of ways and that when your doctors office did the referral, then the billing people could have notified the specialist of (your) insurance, since they would have that on their records. Or, prior to your appointment, then the billing office at the specialist office could have called you and confirmed (what) insurance you have, to see if they accept it or not.
My (late) husband went to 3 specialists, and prior to his (1st) appointment their office called us to ask what type of insurance he had so that both us and them knew if they accepted or not.
But the problem you most likely will have is that in your case, it “appears” you are on some kind of Medicaid, and if so, then finding (any) doctor/specialist to take will be difficult, especially taking (new) patients. So unfortunately, in the future you will need to confirm (prior) to any appointment by giving them the name/ID #/group # etc from (your) health insurance card so that they can verify if they accept or not.

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acermill 6 months ago

You should think that YOU, and you alone are responsible to check whether a physician's office accepts the plan you have. It is not the responsibility of any physician to check your coverage before you visit. What SHOULD you have done? Prior to visiting the physician, you should have contacted them yourself, giving full information concerning the plan you have. At that time, you would have been informed that they did not accept your plan.

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Bosung 6 months ago

c

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David B 6 months ago

It sounds like the doctor's office that made the referral screwed up. You should call them and tell them what happened and request another referral.

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Diane A 6 months ago

I think it was a simple misunderstanding or oversight. Probably not lying. Your doc office probably just did not realize about the community health plan, didn't think. Insurance is tricky. They don't have to go into detail about your insurance and the plum office probably didn't clarify.

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