"OUT OF NETWORK" - Page 2

SeaMaiden · ‎03-10-2010

Yes. It is important to be proactive and call and verify before surgery or checkups that everyone you are going to see are in network.

hopi · ‎03-09-2010

@151949 wrote:
I had a mammogram this morning - as if that isn't a bad enough way to start the day , as I was leaving the receptionist calls me over to say I should check with my insurance because they may no longer be "In network" with my insurance. My heart fell to my stomach! OMG - how much is this going to cost? I got home and called my ins co and they said the center was no longer in their network but that they had a legal responsibilioty to inform me of that before the test was done, not after. She said I will get a letter denying the coverage then I can call and my ins co will fight with the radiology center and make them do it free because they had a responsibility to notify me they were no longer in network. What a pain in the neck ! I feel certain that receptionist looked up my insurance and knew while I was sitting in the waiting room it would not be paid for. There was only me and a couple other people there , so they were not busy.
I'm mad at myself too for assuming that just because they have been in network for the past 5 years that they still are - I'm usually so careful about stuff like this.

So sorry this happened to you. Some people in health care are so horrible it's a disgrace. I know you came to vent your frustration but hopefully it will work out.

Lipstickdiva · ‎03-10-2010

@hoosieroriginal wrote:
I feel the mammographer should tell you if it is not covered by your insurance. I had a mammogram ordered by dr because I found a lump and because it was a "special" mammogram, my insurance did not cover it. I was absolutely furious and said they should have told me that before I had the mammogram. They are now getting $20/mo to pay it off - they can wait for their money!

A mammographer doesn't have anything to do with billing or insurance. They are the ones doing the scan/x-ray and that's it.

For very expensive tests like an MRI, sometimes my doctor will get pre-approval from my insurance company. But for routine things like mammograms, they do not. It's up to me to go to a facility that is in-network.

I'm not sure what kind of "special" mammogram you had to have done that wouldn't have been covered, especially since they found lump. Is it possible you had to pay because you hadn't met your deductible?

That is what happened with me last year. I had to have a diagnostic mammogram, which is more in depth so to speak, than a screening mammogram. I hadn't met my $1500.00 deductible yet with my insurance so I had to pay a huge chunk and my portion was nearly $600.00.

Moonchilde · ‎05-23-2010

@151949 wrote:
if you have a PPO you can go out of network and they pay it but I have an HMO and they do not pay anything for out of network.NOTHING.

And therein lies your problem. The office may be in network for PPO or individual policies but not for HMOs. So they could and would say that you were in network if you didn't remind them you were an HMO patient. And yes, unfortunately not every front office person has all the info and experience they should. I would in future ask to verify with/speak to the insurance person specifically in any future office. But even before that, I would ask at your HMO GP provider's office if they're sure that whatever office they're referring you to is in the HMO network. More leg to stand on, IMO.

Every office I have been in has a sign somewhere in the front (and often multiple signs to include the exam rooms) that it's the patient's responsibility to verify coverage and that the patient is responsible for any charges their insurance doesn't pay - but I understand your unhappy surprise, as it's not always easy to remember everything to do with insurance all the time.

Life without Mexican food is no life at all

ChynnaBlue · ‎05-22-2012

@151949 wrote:
if you have a PPO you can go out of network and they pay it but I have an HMO and they do not pay anything for out of network.NOTHING.

I always check with a doctor or lab before I make an appointment or while I'm calling to make an appointment if I cannot get the information online. I'm sorry you've had a very expensive lesson. Insurance companies are the worst.

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151949 · ‎03-09-2010

@Moonchilde wrote:
@151949 wrote:
if you have a PPO you can go out of network and they pay it but I have an HMO and they do not pay anything for out of network.NOTHING.

And therein lies your problem. The office may be in network for PPO or individual policies but not for HMOs. So they could and would say that you were in network if you didn't remind them you were an HMO patient. And yes, unfortunately not every front office person has all the info and experience they should. I would in future ask to verify with/speak to the insurance person specifically in any future office. But even before that, I would ask at your HMO GP provider's office if they're sure that whatever office they're referring you to is in the HMO network. More leg to stand on, IMO.

Every office I have been in has a sign somewhere in the front (and often multiple signs to include the exam rooms) that it's the patient's responsibility to verify coverage and that the patient is responsible for any charges their insurance doesn't pay - but I understand your unhappy surprise, as it's not always easy to remember everything to do with insurance all the time.

So what - i specifically gave her my 2016 insurance card and it says right on it that it is an HMO. It actually says so in very large letters.

Tissyanne · ‎12-07-2012

It is the patient's responsibility to make sure they are in network. Just because a place "accepts your insurance" does not mean you are in network. Didn't your doctor refer you to a place and you refused so you could go to the one close enough to walk to?

Mj12 · ‎03-09-2010

@Tissyanne wrote:
It is the patient's responsibility to make sure they are in network. Just because a place "accepts your insurance" does not mean you are in network. Didn't your doctor refer you to a place and you refused so you could go to the one close enough to walk to?

True - many doctor's offices will "accept" anything. Doesn't mean at all that it is in network.

Melania · ‎06-12-2013

@151949 wrote:
@Moonchilde wrote:
@151949 wrote:
if you have a PPO you can go out of network and they pay it but I have an HMO and they do not pay anything for out of network.NOTHING.

And therein lies your problem. The office may be in network for PPO or individual policies but not for HMOs. So they could and would say that you were in network if you didn't remind them you were an HMO patient. And yes, unfortunately not every front office person has all the info and experience they should. I would in future ask to verify with/speak to the insurance person specifically in any future office. But even before that, I would ask at your HMO GP provider's office if they're sure that whatever office they're referring you to is in the HMO network. More leg to stand on, IMO.

Every office I have been in has a sign somewhere in the front (and often multiple signs to include the exam rooms) that it's the patient's responsibility to verify coverage and that the patient is responsible for any charges their insurance doesn't pay - but I understand your unhappy surprise, as it's not always easy to remember everything to do with insurance all the time.

So what - i specifically gave her my 2016 insurance card and it says right on it that it is an HMO. It actually says so in very large letters.

So what??

It's a big deal because YOU relied on the receptionist to handle it when they are already stressed to the max and not always trained to know all the different insurances and plans etc. Not only that many of them are just space fillers who have no real training.

Not many staff do...they have a special department for that. Oh and it doesn't matter that the office wasn't busy at all.

Aren't you on medicare? Maybe it would be more cost effective to get a better supplement as this seems to happen often.

Scooby Doo · ‎03-14-2010

Since I am covered by Medicare it doesn't matter where I go to get a mammogram. Medicare pays for it once a year, and my secondary insurance is not billed.