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2 weeks ago my wife and baby got sick with sinus and ear infection. Called a pediatrician (we don't usually go in for anything) They asked me what kind of insurance I had and to send in pictures of my insurance card. I did all of this and they said I was good to go with the appointment that day.

Today I got a text from the doctors office: "Your family was seen and your insurance denied the claim as we are out of network. There is a balance of $750 ."

Why couldn't they tell me the insurance was out of network when I sent in my insurance info before the appts? I don't really know how this stuff works but it's not right. $750 is a lot of money for us.. anything you think I can do? Thanks guys

2 weeks ago my wife and baby got sick with sinus and ear infection. Called a pediatrician (we don't usually go in for anything) They asked me what kind of insurance I had and to send in pictures of my insurance card. I did all of this and they said I was good to go with the appointment that day. Today I got a text from the doctors office: "Your family was seen and your insurance denied the claim as we are out of network. There is a balance of $750 ." Why couldn't they tell me the insurance was out of network when I sent in my insurance info before the appts? I don't really know how this stuff works but it's not right. $750 is a lot of money for us.. anything you think I can do? Thanks guys

(post is archived)

[+] [deleted] 7 pts
[–] 6 pts

Depending on the insurance you may be able to appeal and get a lesser portion of the balance due paid for. Many (although this is changing) insurance plans will pay a portion of out of network fees. You could appeal that this was an emergency because of the child with a fever and that your regular doctor wasn't available.

If that doesn't work, ask the doctor if there is anything you can do to reduce the bill such as paying cash or something. Last, check for local programs that can help pay for this kind of thing, they're out there but hard to find.

Unfortunately, it's legal and insurers suck dick.

[–] 3 pts

Did you ask them if they were in network before you went? Always do this AND verify with your insurance company before visiting any medical or dental provider

It's on you to make sure ahead of time.

And yea what they did was perfectly legal.

Yeah what zzz says here. Plus you need to call your provider and have them give you a list of in net work providers. Most likely you can go to their website and pull up a list of medical providers in your area that are in network. When you call a new provider you ask them, “are you contracted with——- ?” blue cross for example. Do you adhere to blue cross example price agreements. If they charge above the blue cross contracted amount you will have to pay that difference. You need to be with a provider that your insurance company has pre approved.

[–] [deleted] 2 pts

also demand an itemized bill of all the charges and make sure they submitted it to the insurance company properly...

[–] 2 pts (edited )

Refuse. They said it was covered and your decision to use their services was based on it. Or just write them a hot check "Oh sorry, I thought it would cash but I guess it's out-of-network."

Record everything. Get it in writing.

[–] 1 pt

Shit like this is what the clinic is for. Doctor is too busy? Go to the clinic.

Aside from that calling your insurance provider and checking if a place is in network prior to going can work. Some insurances have online portals to check if places are in network.

Now all that said and done it's a bunch of bullshit how much these fucks want to get paid.

[–] 1 pt (edited )

Unless you have a PPO, you MUST always go through your primary care physician for all care except emergency room and urgent care visits. If you need to see a doctor right away and your primary care doctor can't see you, you go to the emergency room or urgent care. You can go to any emergency room anywhere and you are covered however emergency room visits are covered in your plan. Most plans require you to visit specific urgent care centers, so check them out first.

It would be impossible for the doctor's office to research everybody's insurance coverage to find out how their plan will cover them. They can check to see if the insurance is one they accept, but that doesn't mean you're covered for that visit.

It's important to understand these things BEFORE you need urgent medical care.

You might try asking the doctor's office to bill you at the same rate they've negotiated with your insurance company. Many times that's a tiny fraction of the cash price.

[–] 1 pt

Doctors are some of the biggest scammers on Earth. Avoid them for the stuff you described there is nothing they can do but fill you with drugs and send you a massive bill for doing nothing.

[–] 1 pt

It is sketchy as fuck to be sure. I had a problem like this once and here is what I did...

1) get a copy of the chart. This may cost you $10 or so. 2) read every fucking word and look for anything recorded which was not done. Example: "Patient's neck is supple," but the doctor did not examine the neck. 3) write the CEO of the group identifying the unfactual chart entries citing the risk to their business from this fraudulent behavior and demand charges based on a truthful record of treatment. 4) take a lot of phone calls from bitches and make them work their tits off to solve this fucking problem given to them by the CEO. 5) once they are exhausted offer them any non-zero amount you want to go away a satisfied customer. 6) be sure to get a refund for the chart record fee. For extra effect tell them that after you agree on their haircut and take another $30 from them. They don't give any fucks by now - they would probably pay you to leave them alone.

In my case I believe the hospital had default answers configured in the charting software that would then be coded as though the exam of the neck or eyes or whatever was performed. This increases the amount they can bill. It is a massive fraud factory. I offered them about $0.25 on the dollar and they did it. Got my docunent fees back, too.

They are not likely to write it off or give you a pricing break because of your situation. Thank medicare rules for this. You may go for a payment plan that works for you and see how that goes. I went the path of administrative warfare and improved my situation.

You can say fuck it and not pay and deal with collectors. Not sure how that goes, though.

[–] 0 pt (edited )

It's perfectly legal. You should know which providers are and aren't in your network coverage. Yes it's jewish. Yes it's stupid. blah blah blah blah You're an adult. These are things you should know. Yes it sucks. Sure, but your kid is alright I hope.

https://poal.co/s/CRYPTO/517271 = https://archive.ph/6eJYJ You have enough expendible money to dabble in (((crypto))) but $730 is a lot for you?

I call BS.

https://poal.co/s/TellPoal/475745 = https://archive.ph/vzljJ You work in a hospital and don't know this BASIC fact of insurance life?

There's no way this is real.

[–] 0 pt

You're right I was just seeing if people would figure it out. There's a reason you wear the crown.