Physician's proper practice

Question by sly Reward: 25 Pond Points + 10 Knowledge Tokens Status: Pending a resolution
should A physician inform the patient that there health care provider is out of there network before they perform a costly procedure???



Reply from 1stnurse User Rating:  10 Knowledge Tokens
Okay sly,
Part of my answer may not make you happy but here goes anyway. If I were to answer you strictly from the viewpoint of a consumer, my answer might be "yes." The doctor, and certainly the office staff, should be telling you that they are not in the network before any procedure. But the question that may end up hanging you is just how many times should the doctor and his staff remind you that they are not in the network? Did not the places that did the costly procedure want to see your insurance card before the procedure? Most of the time they would want to see the card so that it does not end up being them in trouble for not noting that the provider is out of the network. Did you call the insurance company and double check to see if they have a customer account negotiator that will argue this with the doctor's office? How close is the next place that you could have gotten the same procedure done and had it covered? Sometimes there is a limit to how far the insurance company will be expecting you to travel to accomplish what could have been done in an area that is closer even if it is an out-of-network provider. The health care arena has changed tremendously and patients are expected to take a very responsible part in their own care, so that may be the point on which the insurance company hangs you. Pull phone records and highlight the day that you called the insurance company to check up on their coverage. And whoever it was that told you in the office that it was covered, look at their name tag the next time you go in and write down their name as well as the day that that employee told you it was covered. Good luck!

1st nurse
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