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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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Doctor's
offices should know who their insurance carriers are
April 30, 2004
Q: I just finished
reading the article you wrote about the man who was
sick and had his wife call a doctor from an old insurance
directory. The doctor was no longer contracted with
the patient's insurance company and the claim was processed
as out-of-network. I agreed with everything you said
except for the part about finding out if the $400 bill
can be discounted because this was due to an error by
the doctor's office. The bottom line is that the member
has the responsibility of knowing who is a contracted
provider under their insurance policy, period. The member
has an ID card with an 800 number that can be accessed
to confirm who is participating. Even though the doctor's
office said they are a participating provider, the member
should never rely on a doctor's office to always know
every insurance carrier they are contracted with. The
member needs to be made accountable for this information.
A:
You
are one hundred percent correct. It is ultimately the
patient's responsibility to find out the correct insurance
information. The only information the patient should
rely on should come directly from the insurance company
itself. The patients have a phone number on their insurance
card and they should use it.
However,
patients view their doctors' offices as an authoritative
source of information. If a doctor's office says the
physician is a participating provider of a particular
insurance company, a patient should have no reason to
doubt it. Unfortunately, this is not always the case.
A doctor's office should know what insurance companies
they participate with. They should keep track of this.
The doctors sign a negotiated contract and there is
no reason why a current and accurate list of these insurance
companies can not be kept posted. There is no excuse
for a doctor's office to give patients incorrect insurance
information. The doctor's office should be held accountable
for this mistake. I feel a reduction on this patient's
$400 bill is not only reasonable but appropriate. However,
the doctor is under no obligation whatsoever to discount
his bill and the patient will owe whatever amount the
doctor's office says is his responsibility.
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