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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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Don't
worry about paying a bill until you receive it
July 23, 2004
Q:
I
had surgery over eighteen months ago. I was covered
by my graduate school insurance. Prior to this minor
surgery, I specifically asked the doctor if there would
be any charges I would be accountable for. He said that
if I was under the school insurance policy, I would
not have to pay anything. I even checked with the insurance
company to verify that no pre-certification was needed.
I
ended up paying $600 for biopsy services done by a laboratory
that was out-of-network. The doctor never mentioned
he uses an out-of-network laboratory.
Now
I received a statement from the doctor that lists $3500
as "pending" for insurance. I had been sent
a bill five months ago and was told it was taken care.
While nothing is currently due, I have the feeling that
I may eventually owe this $3500.
Given
that the doctor initially told me this surgery would
cost me nothing and that he has apparently been bungling
around with his own $3500 charge to the insurance company,
is there anything I can do to protect myself? I am no
longer covered under the school insurance policy. I
have very little paper work remaining since I had been
told five months ago that everything was taken care
of. I feel like I will have to wind up in court fighting
either the doctor or the insurance company. I am not
even sure what my rights are.
A:
Physicians
need to be made aware that the laboratory services they
use may be totally independent from the hospital or
the out-patient surgical centers, thereby, these laboratories
may not be covered under the patient's insurance policy.
This is a common problem that I hear over and over.
The physician needs to be made aware of this. I hope
you have spoken to your doctor so he can give accurate
information to his future patients. Health care providers
need to be better educated when it comes to insurance
coverage.
Patients,
like yourself, rarely think to ask if the laboratory
services used by your doctor are covered. Ask if the
surgical facility uses an outside laboratory as opposed
to an in-house laboratory. Call that lab and your insurance
company to verify coverage.
Your
$3500 surgical bill should be covered by your insurance
company. Call your insurance representative and check
on the status of this claim. They will inform you as
to the reason for the delay of their payment to your
surgeon. This explanation will tell you exactly what
is going on with the claim. You will know if there are
any problems and how to proceed.
Keep
in mind one of my fundamental rules. Don't worry about
paying a bill until you receive it. So far you have
not been billed for the $3500.
Don't
worry about paperwork or not being currently covered
by the school insurance. Between the insurance company
and your doctor's office, they have all of the paperwork
you would need. Each of them should supply you with
copies of all correspondence upon your request.
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