Author Topic: Medical Group no longer contracting with my INS- Didn't tell me. Want me to pay  (Read 890 times)

Caslon

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I have Medi-cal which pays my Blue Shield premiums. I go to my primary. He refers me to a dermatologist. I wait and receive authorization. This means the dermatologist on their list and I'll be covered. His name is Dr. Xyz. I call that medical group office and they make me an appointment to see him. I arrive there and "the doctor will see you." He freezes off some precancerous spots. One spot needs a follow up freeze off. Fine. I'm given an appointment date with him but will naturally will have to wait for the authorization for it. Situation normal. On the day of that follow up visit, I'm told their medical group doesn't contract with my insurance company anymore. Appointment is canceled. On my first visit, they most likely didn't check and tell me they were no longer contracting with my insurance company. I would then naturally have declined that first treatment since I'd have to pay for it myself. That medical group has now sent me a bill for $455 for that first visit. A visit where I was NOT informed I wasn't covered, even tho I got written authorization to see them via my primary physicians office. Who is at fault here? My primary for referring me for a paid for authorized visit or that medical group who never informed me they stopped contracting with my insurance company, OR BOTH???!!  I assume these two parties will work it out?  I'm sure as hell not paying for it even if I have to settle it in court (Small claims court).  BTW, this is the second instance of my primary giving authorization and my getting a call the day of my appointment (a different medical office) that they are no longer contracting with my insurance company. At least that one office told me beforehand. This latest instance, they didn't do that.  It was..."hi, the doctor will see you now." They only informed me on my follow up visit I wasn't covered with them. Now they want $455 from me.
 
« Last Edit: November 17, 2020, 02:09:42 AM by Caslon »

Michele

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Who is at fault here? My primary for referring me for a paid for authorized visit or that medical group who never informed me they stopped contracting with my insurance company, OR BOTH???!!
 

First, do you have Blue Shield primary and Medi-Cal secondary?

If you are Medi-Cal eligible are they legally able to bill you?  Are they aware you have Medi-Cal?

OK, so it's hard to answer your question without knowing those answers, but I believe you stated that your insurance authorized the visit?  If the visit was authorized the provider would have to be in network.  There's just some confusing things going on.  Was the dermatologist's office aware of your insurance prior to your visit?  It seems that if they were aware of your insurance they certainly should have notified you prior to the visit.  But again it comes back to Medi-Cal.
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