insurance update
Upon paying the remaining balance due on the promissory note in person at the surgery center, I asked if the insurance claims that had been paid by my provider were in-network or out-of-network. All other claims had been paid as out-of-network. They insisted it had something to do with “my plan” versus other plans, but in reality my insurance provider honored the out-of-network claim and added it to my deductible. The real issue is that I was referred to an out-of-network provider and told otherwise.
I went to the doctors’s office and was told that the surgery center had told them that they were an in-network provider for my insurance company and just recently mailed them a retraction as of November 1st. Though they had the document that lists that information in hand, they were unable to provide a copy without the doctor’s permission. Perfectly understandable. It seems that the surgery center is largely responsible for the screw up because it is their contract which is in negotiation and in my multiple contacts with them the admin staff gave conflicting information about their in/out status with my insurance provider. The initial follow up call on things even indicated that they had contacted my insurance provider and learned that they would be issuing me a check. In subsequent calls this changed and suddenly the surgery center was found to be out-of-network. The surgery center staff conferenced a call with my insurance provider and when I mentioned that in previous calls I was told that the center was in-network the surgery center staff member flatly (and firmly) denied ever saying that.
I happened to bump into my doctor as I was leaving the building and I gave a brief explanation of what was going on and he said he would be happy to provide information to the insurance company to straighten things out. I wonder if he will be able to assist me with my dealings with the surgery center. Good or bad, there is a chance he may even be a part owner. The staff at the doctor’s office didn’t really know, but he does schedule most of his surgeries there. I wonder if there have been multiple patients from my insurance company served on those premises.
My next step is to write a polite letter to the doctor explaining the situation and asking for his help in rectifying things, if possible. Having a copy of that letter referring to insurance contracts would be helpful in establishing who failed to give the proper information resulting in my additional financial burden.
Though this position is somewhat more encouraging than having to engage my doctor adversarialy with financial concerns, there is another exciting twist that I should reiterate.
The original promissory note for the surgery was for the in-network amount. The surgery center indicated that, as a matter of course, they bill all patients for the in-network amount and take on the remainder of the (out-of-network) full cost as a loss. This amounts seems generous as it amounts to $1,035.34 but in reality this money is the savings I am due as an in-network patient if their contract were in place. Because they were wrong about their contract they have not lost any additional money, they have simply given me an additional burden which cannot be applied to my deductible.
I also just found notes from a previous phone call that specifically states I asked and was told that they would be honored as an in-network provider. Now they may have been misinformed when they told me that but it does indicate that I was misled from the beginning.
11 November 2004, 14:54 ::
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