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Linda
Brandwin, R.N.
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Linda
Brandwin
is a registered nurse and a medical billing
and claims specialist. For the past 10 years
she has worked directly with insurance companies
to give advice and guidance to the health care
consumer.
Readers may send email
or write Linda Brandwin at 5500 Single Oak Hill
Ct., Woodbridge, VA 22192.
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Not
asking more questions leads to expensive
bill
Feb. 20, 2004
Q:
I
had out-patient surgery performed six months ago. Since
I knew in advance the date of my surgery, I called my
insurance company to make sure my doctor was in-network.
The insurance company assured me my doctor was. Six
months later I find out that my doctor is in-network,
but that network isn't part of my policy. She is considered
in-network, but not in a preferred provider network
which my insurance plan requires. So, therefore, I now
have to reach an out-of-network deductible and I have
a $480 bill to pay. I just don't understand any of this.
A:
You
are not alone. Many people don't understand it, not
only patients, but doctors, insurance company workers
themselves, billing departments and even the human resource
representatives who administer the plans at your place
of employment. Problems and complications never stop.
Medical insurance just is not easy.
In
your case, you asked the right question. Is my doctor
an in-network physician? You were told yes. But, unfortunately,
sometimes there are more questions to ask. A physician
can be in-network and participate in several plans.
That doesn't mean that the doctor participates in ALL
plans. A better question would have been does my doctor
participate in MY plan. Make sure the insurance representative
you speak to looks up your specific policy. As always,
you will need to document who you spoke to and the date
and time. You never know when you might have to reference
back to this conversation.
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