Eye Doctor Gave Me Wrong Information - Page 2

Tribesters · ‎03-10-2010

Same thing happened to me. I did my research- made sure they were listed on website as participating providers. Then I find out this doctor participates but not in the office I went to. She works one day a week off site & because I went to the local office & not the one 45 minutes away it wasn't covered. Luckily I had a flex spending account so I paid her & got reimbursed from that.

151949 · ‎03-09-2010

If it is on the BCBS website I would fight the claim with them.

151949 · ‎03-09-2010

I have not gone to any doctor for at least the last 20 years who doesn't ask as soon as you walk in the door for your insurance card and before you see the doctor they have verified your insurance and you have paid the copay.

KingstonsMom · ‎03-09-2010

151949 wrote:

I have not gone to any doctor for at least the last 20 years who doesn't ask as soon as you walk in the door for your insurance card and before you see the doctor they have verified your insurance and you have paid the copay.

Here, they copy your insurance card when you sign in, but co-pays or charges aren't until you check out.

And just because you pay a co-pay at the appt., doesn't mean the claim will be approved when it's processed.

You never know how strong you are until being strong is the only choice you have.

Reba055 · ‎06-23-2014

That happened to me with a lab and they billed me $2000.00. My insurance company said I should have checked right before going, sorry. This was a lab that had always been in my network and was a few weeks before. I was fuming as I pay zero at a lab in my network. I wrote them a letter (and mailed certified) explaining that I felt like they purposely lied to me and told me they were in network as a way to make money and that if they didn't clear out my bill that I was going to report them to the Florida Insurance Commissioner (and I was going to) and my local and state representatives as I was sure I wasn't the only person they had done this to. They removed the charges "as a courtesy" to me.

VaBelle35 · ‎03-10-2010

I would start with the billing department at your doctor's office first. Many times, they simply did not put the correct doctor's name on the billing.

For example, when I go to the family practice here in town, I see Dr. X. But the EOB says Dr. Y. Because Dr. Y is in Cigna and I have Cigna. If I had Aetna, I would probably see Dr. A on the EOB.

If that isn't it, then take it up with BCBS.

===================================
QVC Shopper - 1993

# IAMTEAMWEN

Silver Lining · ‎04-16-2010

@SF Girl wrote:
I had an eye emergency and went to my eye doctor of 35 years. The M.D. I was going to is retired, so I went to a new person. I asked the girls at the desk if they take my Blue Cross plan. They said yes.

Well, I had to go back 3x to see the doctor (that's a whole other story). But, I get my explanation of benefits from BCBS and they are not in network! Now I have to pay $100 for each visit! They told me otherwise. And, on the BCBS website, it had them listed for taking my insurance.

The billing dept probably will tell me "too bad," but I asked them and was told they took my plan.

Doctors have become thieves. They are charging so much for appts and then not giving you the proper care or information. I was a long-time established patient!

I don't know what to do! I have since started with a new eye doctor who does take the plan and are so professional. But, I have bills to incur that I can't afford right now.

Have you actually received a bill from that doctor's office? You said you received the BCBS explanation of charges. It is not a bill.

Carmie · ‎10-25-2010

Insurance is complicated. Your eye doctor probably does participate with BCBS. The question to ask is do they participate with your plan.

Do you have a PPO, HMO,EPO. HSA or another plan? Many providers accept insurance from BCBS, but they do not participate in all of their offerings.

I would first try to negotiate with the doctor's office to see if they will accept what the insurance has paid, if any.

If there was no payment, or they refuse, I would write a letter of appeal to BCBS and ask them to make an exception and pay for this provider because you were told they are par and second the website was misleading and you did your best to find a par provider.

BCBS might pay your claims by exception this one time. By law, ALL APPEALS must be made in writing, do not call. Make sure you do so in a timely manner.

Best of luck to you.

Katcat1 · ‎07-21-2011

I would not pay since the eye dr. office said they take your insurance but next time call your insurance and check yourself. However, you would think their word is what matters. Contact your attorney general's office.

kindness is strength

Apple Head · ‎01-31-2015

@Silver Lining wrote:
@SF Girl wrote:
I had an eye emergency and went to my eye doctor of 35 years. The M.D. I was going to is retired, so I went to a new person. I asked the girls at the desk if they take my Blue Cross plan. They said yes.

Well, I had to go back 3x to see the doctor (that's a whole other story). But, I get my explanation of benefits from BCBS and they are not in network! Now I have to pay $100 for each visit! They told me otherwise. And, on the BCBS website, it had them listed for taking my insurance.

The billing dept probably will tell me "too bad," but I asked them and was told they took my plan.

Doctors have become thieves. They are charging so much for appts and then not giving you the proper care or information. I was a long-time established patient!

I don't know what to do! I have since started with a new eye doctor who does take the plan and are so professional. But, I have bills to incur that I can't afford right now.

Have you actually received a bill from that doctor's office? You said you received the BCBS explanation of charges. It is not a bill.

The explanation stated that the services were not covered due to the doctor being out of network.

I have since left this practice because the doctor was not very efficient nor respectful.I had to start over at a new office where they are very professional and the billing dept so kind.

I had been going to that other office for 35 years.

My insurance does not have a co-pay as I'm on a very high deductible, the only one I could afford right now.

Thank you for the good feedback.