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Can You Be Billed for a Medical Procedure Not Covered by Insurance

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  • 02-14-2017, 09:40 AM
    Hack73
    Can You Be Billed for a Medical Procedure Not Covered by Insurance
    My question involves malpractice in the state of: Roanoke, VA.

    I started seeing a Dr. for my back. He wanted to try carterizing some nerves and I agreed but first we had to do a "test" where he would shoot lidocaine around the disk to see if I got relief. When I returned for the next appointment, he said we had to do a 2nd test run due to my insurance. Third visit he proceed with the actual nerve carterization. Later I get a bill for 1500.00 because the 2nd test procedure was not covered by my insurance. The insurance company BCBS said that they did not require the 2nd test. Now the Dr. has sent it to collections. I have contacted several lawyers locally and each time am told "we don't handle cases like that". I am desperate for help and would be very grateful for any advise or guidance.

    Thanks,
    Hack73
  • 02-14-2017, 11:54 AM
    Mark47n
    Re: Can You Be Billed for a Medical Procedure Not Covered by Insurance
    The test was performed, with your consent. By giving consent you are also consent to pay the bill if insurance denies it. The doctor is not an agent of your insurance as, as such, cannot be expected to be responsible for knowing everything about your coverage and, it's possible that they received conflicting information from the insurance coverage. It is your responsibility to know what your coverage is and, if there are questions, to get answers yourselfincluding whether or not the procedure is, in fact, covered.

    Welcome to the land of for profit healthcare where you, the patient, can get screwed from both ends.
  • 02-15-2017, 06:02 AM
    Mr. Knowitall
    Re: Can You Be Billed for a Medical Procedure Not Covered by Insurance
    Should we infer that the doctor is out of network? If so, it behooves you to verify on your own whether or not procedures will be covered, as you can't count on the doctor to know.

    Note also, you have not told us that the doctor promised you that the second procedure would be covered -- but have indicated instead that told you that it was needed for some reason relating to your insurance coverage for the third procedure.
  • 02-15-2017, 11:41 AM
    Hack73
    Re: Can You Be Billed for a Medical Procedure Not Covered by Insurance
    Thank you for taking time to reply. The dr. is in network. He just said that it was required due to my insurance. However, my insurance company told me that was false and they did not require a second test.
  • 02-15-2017, 11:48 AM
    Mark47n
    Re: Can You Be Billed for a Medical Procedure Not Covered by Insurance
    Quote:

    Quoting Hack73
    View Post
    Thank you for taking time to reply. The dr. is in network. He just said that it was required due to my insurance. However, my insurance company told me that was false and they did not require a second test.


    But that doesn't relieve you of the obligation to do your due diligence. While you can certainly file an appeal with the insurance company and contest it with the doctor/hospital, you'll likely end up paying it.
  • 02-15-2017, 11:49 AM
    cbg
    Re: Can You Be Billed for a Medical Procedure Not Covered by Insurance
    At what point did you (not the doctor, but YOU) pick up the phone and ask the insurance company what was required and what was covered?
  • 02-16-2017, 10:48 AM
    Hack73
    Re: Can You Be Billed for a Medical Procedure Not Covered by Insurance
    At my next follow up appointment I was informed that I owed 1700.00. I went directly home and called my insurance. They informed me that I was bring charged for the 2nd set of test injections and that theyou did not require them.

    Another detail that forgot to mention is in later conversation going back and forth between insurance and dr, the billing girl told me that the insurance was charging for 2 injections for each bilateral and that everyone else's only charges for 1. Still don't explain why the dr lied to me though.

    Thanks again for your time.
  • 02-16-2017, 11:04 AM
    Mark47n
    Re: Can You Be Billed for a Medical Procedure Not Covered by Insurance
    The time to call your insurance is BEFORE the procedure, not after. They aren't required to cover it but you are obligated to pay for it, one way or another.

    Her's the question you would have to answer if you tried to sue; can you prove that the doctor lied to you. You'd probably be asked why would the doctor bother? You would also be asked why you didn't confirm the approval with the insurance as that is not the doctor's responsibility, it's yours.
  • 02-16-2017, 02:55 PM
    jk
    Re: Can You Be Billed for a Medical Procedure Not Covered by Insurance
    Ok, try a different tack.

    Apparently the doctor required the test, for whatever reason. If the doctor required the test then insurance should cover it. If the doctor didn't require it and If you have a ppo insurance then the doctor must accept what the insurance provider pays per their schedule and contract with the doctor and cannot balance bill you.
  • 02-16-2017, 03:13 PM
    cbg
    Re: Can You Be Billed for a Medical Procedure Not Covered by Insurance
    It's not quite that simple, though that may end up being how it works out. PPO's are the mostly loosely run of managed care plans and the employee has a lot more freedom than in, say, an HMO. That freedom means that sometimes the cost share can increase.

    What I would recommend is that the poster call the insurance carrier again - not Member Services, but Provider Relations, or whatever his carrier calls the department that oversees the doctors' contracts'. They will be able to look at the specific claim and the contract he is covered under and determine exactly what he does and does not owe, and what the doctor has to eat. They are also the ones that would discipline the doctor if he is in violation of his contract.
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