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  1. #1
    Join Date
    Feb 2017
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    Default 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

  2. #2
    Join Date
    Nov 2015
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    47.606 N 122.332 W in body, still at 90 S in my mind.
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    Default 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.

  3. #3
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    Default 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.

  4. #4
    Join Date
    Feb 2017
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    5

    Default 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.

  5. #5
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    Default Re: Can You Be Billed for a Medical Procedure Not Covered by Insurance

    Quote Quoting Hack73
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    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.

  6. #6
    Join Date
    Jun 2006
    Location
    Massachusetts
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    24,521

    Default 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?

  7. #7
    Join Date
    Feb 2017
    Posts
    5

    Default 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.

  8. #8
    Join Date
    Nov 2015
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    47.606 N 122.332 W in body, still at 90 S in my mind.
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    Default 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.

  9. #9
    Join Date
    Jan 2006
    Posts
    38,867

    Default 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.

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