r/personalfinance • u/trebory6 ​ • Sep 02 '22

Psychiatrist did not verify my insurance before our appointment. They say they don't take my insurance, my insurance says they do. Now the psychiatrist is asking me to pay out of pocket Insurance

So Psychiatrist did not verify my insurance before our appointment. They say they don't take my insurance, my insurance says they do. Now the psychiatrist is asking me to pay out of pocket while my insurance is saying they can't do anything because they can't force the provider to use insurance. What can I do?

Edit: I just got off the phone on a 3 way call between my insurance and provider assistant, and my insurance basically no bullshitted the assistant by asking for the tax number and another number and then confirmed 100% that they are in network and provided all the information, and that she'd have to put in a report if they still say they can't accept my insurance.

Assistant ended up saying they called my provider and they'll use some "old system" to bill me, and the 3rd party verifier they use was adamant they weren't in network for me.

They ended up complying and allowing me to pay my $50 copay. So either it was an obstinate assistant or just typical insurance bullshit. lol

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56

u/[deleted] Sep 03 '22

Doesn't the insurance company have a responsibility to keep their listings up to date? How is the patient supposed to navigate this?

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u/Ok_Resident_4495 ​ Sep 03 '22

I don’t know how these insurance companies justify doing what they do ow why. The only answer is that these insurance companies just do not care. As a patient looking for a psychiatrist know that most if everyone on the insurance list is probably a lie or not taking new patients. The family member I’m talking about stopped taking insurance because the ins co was super shady.

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u/shadow_chance ​ Sep 03 '22

Hahahahaha why would they want accurate lists? That would mean patients would be able to easily use the service they bought and the insurer would have to pay more claims.

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u/[deleted] Sep 03 '22

[removed] — view removed comment

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u/[deleted] Sep 03 '22

I don't really care whose fault it is that records aren't being updated. If the insurance is giving wrong information it shouldn't be the patient's responsibility to clear it up.

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u/[deleted] Sep 03 '22

It's not. If the Insurer has affirmatively stated that the Provider is in-network, they cannot deny for network reasons after the fact.

"Affirmatively stating" can and has been judged to include the Insurer's provider directory on their website.

When this happens, you call your insurer, and say "Provider X is listed as in-network on your website. Per the No Surprises Act that went into effect on 1/1/2022, you are required to cover their services as in-network."

Source: https://www.consumerfinance.gov/ask-cfpb/what-is-a-surprise-medical-bill-and-what-should-i-know-about-the-no-surprises-act-en-2123/

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u/163700 ​ Sep 03 '22

I think putting all the blame on providers is a bit misleading. I've worked at several offices where the provider before me retired and is still listed as being an in network provider over a year later despite multiple correspondences back and forth with insurance companies. I'd argue that the only party that stands to benefit from not deactivating a provider is the insurance company. The providers office doesn't enjoy taking daily/weekly phone calls wasting time asking if they are in network with an old insurance and then having to turn people down. The insurance company gets to make it look like they have plenty of providers to make their product look more appealing to customers.

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u/speedracer73 ​ Sep 03 '22

agreed, the above poster is an insurance shill.

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u/speedracer73 ​ Sep 03 '22

The insurance company should know if they haven’t gotten a bill from a doctor for 3 months, 6 months, a year. Maybe insurance could contact that doctor and ask what’s going on. Insurance has no incentive to remove doctors from their list, a bigger list makes it look like the company provides better access. There’s no benefit on the doctor side to be incorrectly included on the list. Insurance makes billions per year I think they can handle this. I can’t believe you blame the individual doctor.

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u/speedracer73 ​ Sep 03 '22

I'm guessing doctors don't have time in between calling for prior authorizations for generic meds a patient has been on for 10 years.

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u/QV79Y ​ Sep 03 '22

You might find something in small print saying you have to verify it with the provider. I have seen that. There can be a time lag when providers end their contracts.

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u/RozenKristal ​ Sep 03 '22

They outsource staff to India… making it extremely slow and a hassle to deal with from providers end. Remember, insurance make money by paying out less than the money they collect from premiums. Making it seamless process means less profits for them.

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u/[deleted] Sep 03 '22

Remember, insurance make money by paying out less than the money they collect from premiums

Their main source of income is generally investing the money they collect from premiums.

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u/RexHavoc879 ​ Sep 03 '22

Which is why they not only try very hard to find excuses to deny claims, but also drag their feet on paying, to maximize the time in which that money is earning them capital gains.

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u/sambull ​ Sep 03 '22

from a couple of my neighbors, they just get your house in the end it seems.. or that is, they make you so poor you end up selling it.

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u/[deleted] Sep 03 '22

My fiance is an lcsw. She has to write a letter to the state insurance commissioner about once a month to get insurance companies to fix a gigantic fuck up they made. If she doesn't get them involved then the insurance company will just give her the runaround and not do shit to solve the problem

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u/speedracer73 ​ Sep 03 '22

insurance companies suck. They don’t have big glass buildings because they are nice and helpful.