What will happen if I refuse to pay a medical bill?

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R2D2
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Re: What will happen if I refuse to pay a medical bill?

Post by R2D2 » Sun Oct 01, 2017 8:58 pm

toofache32 wrote:
Sun Oct 01, 2017 8:54 pm
R2D2 wrote:
Sun Oct 01, 2017 8:44 pm
staythecourse wrote:
Sun Oct 01, 2017 7:32 pm
In the end, it ALL depends if the office stated "Yes we are in network" or "Yes we accept your insurance". That difference is obviously a big one.
Sorry, I've read through most of this thread and I'm honestly not sure which question I'm supposed to ask. In the past, I've checked the insurance company's web site *and* asked the doctor's office if they take my insurance *and* made sure that I was charged the in-network copay when I arrived. Is this not the correct procedure?
"Taking" insurance is not the same as being in-network. In my office, I am not in-network with insurance, but I will "take" payment from either the patient or the insurance company. When it's from an insurance company, this is called assignment of benefits (AOB) and is used by both in-network and out-of-network providers. This is to distinguish out-of-network providers who require the patient to pay the full fee up front and let the patient chase after the insurance for reimbursement (no AOB needed). With assignment of benefits, the patient signs a document allowing the provider to step in the shoes of the patient and bill the insurance company directly.
Thanks. So I should ask if the doctor is in-network for my insurance? And then am I done or do I have to check the ins company's web site as well? Or call them?

toofache32
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Re: What will happen if I refuse to pay a medical bill?

Post by toofache32 » Sun Oct 01, 2017 9:05 pm

R2D2 wrote:
Sun Oct 01, 2017 8:58 pm
toofache32 wrote:
Sun Oct 01, 2017 8:54 pm
R2D2 wrote:
Sun Oct 01, 2017 8:44 pm
staythecourse wrote:
Sun Oct 01, 2017 7:32 pm
In the end, it ALL depends if the office stated "Yes we are in network" or "Yes we accept your insurance". That difference is obviously a big one.
Sorry, I've read through most of this thread and I'm honestly not sure which question I'm supposed to ask. In the past, I've checked the insurance company's web site *and* asked the doctor's office if they take my insurance *and* made sure that I was charged the in-network copay when I arrived. Is this not the correct procedure?
"Taking" insurance is not the same as being in-network. In my office, I am not in-network with insurance, but I will "take" payment from either the patient or the insurance company. When it's from an insurance company, this is called assignment of benefits (AOB) and is used by both in-network and out-of-network providers. This is to distinguish out-of-network providers who require the patient to pay the full fee up front and let the patient chase after the insurance for reimbursement (no AOB needed). With assignment of benefits, the patient signs a document allowing the provider to step in the shoes of the patient and bill the insurance company directly.
Thanks. So I should ask if the doctor is in-network for my insurance? And then am I done or do I have to check the ins company's web site as well? Or call them?
If you really want to be as certain as possible, ask both.

SimonJester
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Re: What will happen if I refuse to pay a medical bill?

Post by SimonJester » Sun Oct 01, 2017 9:55 pm

$172 a Dr visit doesn't sound out of line, mine are $194 each and this is the in-network discounted rate.

I would pay it and move on, or continue to argue with your insurance company. Your beef is between you and them not the DR.

Do you really want the bill going to collections and having to deal with that mess?
"They who can give up essential liberty to obtain a little temporary safety, deserve neither liberty nor safety." - Benjamin Franklin

staythecourse
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Re: What will happen if I refuse to pay a medical bill?

Post by staythecourse » Mon Oct 02, 2017 8:32 am

R2D2 wrote:
Sun Oct 01, 2017 8:44 pm
staythecourse wrote:
Sun Oct 01, 2017 7:32 pm
In the end, it ALL depends if the office stated "Yes we are in network" or "Yes we accept your insurance". That difference is obviously a big one.
Sorry, I've read through most of this thread and I'm honestly not sure which question I'm supposed to ask. In the past, I've checked the insurance company's web site *and* asked the doctor's office if they take my insurance *and* made sure that I was charged the in-network copay when I arrived. Is this not the correct procedure?
Yes that is the perfect question to ask and confirm with the insurance company by phone. 1. Do you accept my insurance and 2. Are you in network. Just make sure it is confirmed with your insurance company as I would not trust ANY office to stand by their words if rubber meets the road. It is not fair, but there are plenty of incompetent and devious folks in medicine (unfortunately) just like any other field of life.

Good luck.
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dm200
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Re: What will happen if I refuse to pay a medical bill?

Post by dm200 » Mon Oct 02, 2017 8:42 am

staythecourse wrote:
Mon Oct 02, 2017 8:32 am
R2D2 wrote:
Sun Oct 01, 2017 8:44 pm
staythecourse wrote:
Sun Oct 01, 2017 7:32 pm
In the end, it ALL depends if the office stated "Yes we are in network" or "Yes we accept your insurance". That difference is obviously a big one.
Sorry, I've read through most of this thread and I'm honestly not sure which question I'm supposed to ask. In the past, I've checked the insurance company's web site *and* asked the doctor's office if they take my insurance *and* made sure that I was charged the in-network copay when I arrived. Is this not the correct procedure?
Yes that is the perfect question to ask and confirm with the insurance company by phone. 1. Do you accept my insurance and 2. Are you in network. Just make sure it is confirmed with your insurance company as I would not trust ANY office to stand by their words if rubber meets the road. It is not fair, but there are plenty of incompetent and devious folks in medicine (unfortunately) just like any other field of life.
Good luck.
I suspect it may not be applicable for office visits, but I recall that you can get pre-authorization in writing from an insurance company for certain types of tests/procedures with certain providers.

SimonJester
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Re: What will happen if I refuse to pay a medical bill?

Post by SimonJester » Mon Oct 02, 2017 9:25 am

dm200 wrote:
Mon Oct 02, 2017 8:42 am
I suspect it may not be applicable for office visits, but I recall that you can get pre-authorization in writing from an insurance company for certain types of tests/procedures with certain providers.
My wife had an insurance company try and refuse to pay a hospital bill that was pre-authorized, and required to be covered per the ACA. The bill was over $8,000 and it took months to finally get them to pay it. We had to pull in the US Department of Labor (DOL mediates and gets involved with ACA issues), our State Insurance division (who rejected our claim because ACA issues were not state insurance issues). Finally it took an email to the CEO of the insurance company to resolve the issue.

The DOL Agent we were working with told us they have seen insurance companies pay out a claim only to "claw it back" many years later and retroactively deny the claim. The agent indicated this was a common practice with this mega national health insurance company.

The whole system is broken and we need to start paying cash at the time of service, then submitting our own insurance claims. Once this happens consumers will get fed up enough with the insurance shenanigans and demand change. We also need to decouple insurance from employers so we see the true price and can truly have a competitive market place for insurance.
"They who can give up essential liberty to obtain a little temporary safety, deserve neither liberty nor safety." - Benjamin Franklin

stoptothink
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Re: What will happen if I refuse to pay a medical bill?

Post by stoptothink » Mon Oct 02, 2017 9:30 am

toofache32 wrote:
Sun Oct 01, 2017 9:05 pm
R2D2 wrote:
Sun Oct 01, 2017 8:58 pm
toofache32 wrote:
Sun Oct 01, 2017 8:54 pm
R2D2 wrote:
Sun Oct 01, 2017 8:44 pm
staythecourse wrote:
Sun Oct 01, 2017 7:32 pm
In the end, it ALL depends if the office stated "Yes we are in network" or "Yes we accept your insurance". That difference is obviously a big one.
Sorry, I've read through most of this thread and I'm honestly not sure which question I'm supposed to ask. In the past, I've checked the insurance company's web site *and* asked the doctor's office if they take my insurance *and* made sure that I was charged the in-network copay when I arrived. Is this not the correct procedure?
"Taking" insurance is not the same as being in-network. In my office, I am not in-network with insurance, but I will "take" payment from either the patient or the insurance company. When it's from an insurance company, this is called assignment of benefits (AOB) and is used by both in-network and out-of-network providers. This is to distinguish out-of-network providers who require the patient to pay the full fee up front and let the patient chase after the insurance for reimbursement (no AOB needed). With assignment of benefits, the patient signs a document allowing the provider to step in the shoes of the patient and bill the insurance company directly.
Thanks. So I should ask if the doctor is in-network for my insurance? And then am I done or do I have to check the ins company's web site as well? Or call them?
If you really want to be as certain as possible, ask both.
As evidenced by my experience, that doesn't always work either.

Jack FFR1846
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Re: What will happen if I refuse to pay a medical bill?

Post by Jack FFR1846 » Mon Oct 02, 2017 9:55 am

We seem to find tons of issues with the insurance/provider networks. A couple that we dealt with over the last couple years:

I switched jobs, so had to figure out all of our existing provider relationships with our new health insurance, provider network (go between....I'll call them Cigna), and prescription coverage.

For son #1, one provider had been attempting to become a Cigna provider for 3 years. Called Cigna and they told me that they had enough of that specialty in my area so would not accept any new ones. I asked that they send me a list and they did. Out of the 10 they sent, 1 was dead, 1 was retired and several had moved to other areas. Great. We pay the out-of-network cost for this provider.

For son #2, we needed to find a new provider for a specialty. Cigna pointed us to a bunch of facilities. Ironically, their highest recommendation was just shut down by the state over the summer for excessive violations, code violations and lack of training. Great. Another facility was actually excellent and we called them. They said that they no longer accept Cigna because theyCigna doesn't pay their bills. Again, great.
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toofache32
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Re: What will happen if I refuse to pay a medical bill?

Post by toofache32 » Mon Oct 02, 2017 10:58 am

SimonJester wrote:
Mon Oct 02, 2017 9:25 am
My wife had an insurance company try and refuse to pay a hospital bill that was pre-authorized, and required to be covered per the ACA. The bill was over $8,000 and it took months to finally get them to pay it. We had to pull in the US Department of Labor (DOL mediates and gets involved with ACA issues), our State Insurance division (who rejected our claim because ACA issues were not state insurance issues). Finally it took an email to the CEO of the insurance company to resolve the issue.

The DOL Agent we were working with told us they have seen insurance companies pay out a claim only to "claw it back" many years later and retroactively deny the claim. The agent indicated this was a common practice with this mega national health insurance company.
These clawbacks are a hidden tool of the insurance industry, especially Medicare. They hire RAC auditors to review hospital records. They look for any areas where someone put a period in the wrong place and cry "fraud, waste and abuse" to require the hospital to pay it back. They get 10% of every dollar they can reclaim....talk about a conflict of interest.

toofache32
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Re: What will happen if I refuse to pay a medical bill?

Post by toofache32 » Mon Oct 02, 2017 11:02 am

Jack FFR1846 wrote:
Mon Oct 02, 2017 9:55 am
For son #1, one provider had been attempting to become a Cigna provider for 3 years. Called Cigna and they told me that they had enough of that specialty in my area so would not accept any new ones. I asked that they send me a list and they did. Out of the 10 they sent, 1 was dead, 1 was retired and several had moved to other areas. Great. We pay the out-of-network cost for this provider.
I was that doctor for Cigna when I tried to do the same thing a few years ago. I was seeing numerous employees of my hospital (who gives Cigna to employees) in my private office. Cigna would not return my calls when I wanted to discuss signing up. So I called the HR department at our hospital and even they could not get Cigna to give me the time of day.

toofache32
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Re: What will happen if I refuse to pay a medical bill?

Post by toofache32 » Mon Oct 02, 2017 11:05 am

dm200 wrote:
Mon Oct 02, 2017 8:42 am
I suspect it may not be applicable for office visits, but I recall that you can get pre-authorization in writing from an insurance company for certain types of tests/procedures with certain providers.
A pre-authorization does not guarantee anything and means nothing. At the bottom of every pre-auth is the fine print "pre-authorization of services is not a guarantee of payment." In other words, they reserve the right to change their minds at any time. And they do. A pre-auth is just another hoop to jump through to delay care.

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flamesabers
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Re: What will happen if I refuse to pay a medical bill?

Post by flamesabers » Mon Oct 02, 2017 11:15 am

SimonJester wrote:
Mon Oct 02, 2017 9:25 am
The whole system is broken and we need to start paying cash at the time of service, then submitting our own insurance claims. Once this happens consumers will get fed up enough with the insurance shenanigans and demand change. We also need to decouple insurance from employers so we see the true price and can truly have a competitive market place for insurance.
Ironically, we already have this kind of system for pet insurance.

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dm200
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Re: What will happen if I refuse to pay a medical bill?

Post by dm200 » Mon Oct 02, 2017 11:21 am

toofache32 wrote:
Mon Oct 02, 2017 11:05 am
dm200 wrote:
Mon Oct 02, 2017 8:42 am
I suspect it may not be applicable for office visits, but I recall that you can get pre-authorization in writing from an insurance company for certain types of tests/procedures with certain providers.
A pre-authorization does not guarantee anything and means nothing. At the bottom of every pre-auth is the fine print "pre-authorization of services is not a guarantee of payment." In other words, they reserve the right to change their minds at any time. And they do. A pre-auth is just another hoop to jump through to delay care.
Good grief! Learn something new every day...

Under previous coverage years ago, I had eyelid surgery and the Ophthalmologist took a few paperwork shortcuts in filing and justifying the surgery as "medically necessary" (which it was). It took a year, back and forth, for the claim to be paid. The issue (which I understand) is that such surgery for purely cosmetic reasons is identical to what I had/needed for medical reasons. A few years later, I needed the surgery again. This time, I spoke with the business person at the practice and pressed them to document and justify the surgery at every step along the way. The claim was paid promptly without any questions.

petiejoe
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Re: What will happen if I refuse to pay a medical bill?

Post by petiejoe » Mon Oct 02, 2017 6:46 pm

OnTrack wrote:
Sat Sep 30, 2017 6:49 pm
petiejoe wrote:
Sat Sep 30, 2017 1:05 pm
Multiple people have tried to help you understand the difference between accepting a particular insurance and being in-network. This is a very important distinction. It is not the fault of the doctor's office that you don't understand the distinction and asked the wrong question.
So if I understand this correctly, as long as a doctor's office is willing to bill the patient's insurance company, then the answer to the question "Do you accept the xyz insurance plan." will always be "yes." Although that may be technically correct, a better answer would be "We will bill your insurance company, but I cannot tell you if they will pay the bill. To find that out you need to ask your insurance company." It would also be useful to state that the doctor is not an "in network" doctor if that is the case. Sometimes a yes or no answer while technically correct can leave the wrong understanding to a layperson.
No, some doctors offices will not accept some insurances. Usually it will be a situation where the insurance company doesn't cooperate in good faith. My local walk-in clinic has a check for $.02 taped to the window to explain why they don't accept some insurance plans. A lot of insurance plans will still cover some portion of out of network visits after a deductible, so the person at the doctor's office won't be thinking about all the subtle details of your insurance when you ask such a broad question. As far as the person at the front desk knows, they take your insurance and they'll submit the billing to that insurance on your behalf. Which is what was asked. Read the details of your insurance plan - this isn't even the fine print, this is the basic rules for how insurance works. Yes, it totally sucks, but that's how it works. Instead of stiffing the doctor's office, write a letter to your congressperson explaining why single payer would be better than this horrible insurance scheme.

maria00200
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Re: What will happen if I refuse to pay a medical bill?

Post by maria00200 » Mon Oct 02, 2017 7:01 pm

Something similar happened to me. I was told by my primary doctor's office that their "weight loss clinic and nutritional services" were covered by my insurance plan. Well I went and then got a bill by my insurance company. Insurance company stated that they do not cover that. I was livid because it was over $300. So I called the primary doctor, spoke to the billing department and asked them why they told me it was covered when it wasn't. They apologized for the mistake and agreed to only charge me for half of it. I chalked it up as a loss and learned a lesson that from now on, I have to ask the insurance company directly what is and isn't covered. If I were you, I would call the doctor's office and ask to speak with the supervisor of the billing department, explain your situation and see if they would work with you and accept half at least, and then just pay it, learning from the experience. Good luck.

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BogleFanGal
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Re: What will happen if I refuse to pay a medical bill?

Post by BogleFanGal » Mon Oct 02, 2017 7:11 pm

So what happens if it's an emergency situation - ambulance takes you to out of network hospital - or hospital is in network, but ER or intensive care teams aren't and you're not physically able to request "in network"? Are you stuck paying out of pocket for everything?
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dm200
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Re: What will happen if I refuse to pay a medical bill?

Post by dm200 » Mon Oct 02, 2017 7:36 pm

BogleFanGal wrote:
Mon Oct 02, 2017 7:11 pm
So what happens if it's an emergency situation - ambulance takes you to out of network hospital - or hospital is in network, but ER or intensive care teams aren't and you're not physically able to request "in network"? Are you stuck paying out of pocket for everything?
No personal experience - but I can guess...

Not in such a plan now, but I seem to recall that when I was in such "in network" plans there were some exceptions in certain emergency situations.

I am showing my age - but I am reminded of the Jack Benny bit - "Your money or your life!!" https://www.youtube.com/watch?v=yYtfejT4QgM

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VictoriaF
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Re: What will happen if I refuse to pay a medical bill?

Post by VictoriaF » Mon Oct 02, 2017 7:37 pm

docbrown wrote:
Fri Sep 29, 2017 9:43 pm
Plot twist: When I saw that my insurance company rejected payment, but weeks before I received a bill, I figured out what was up and went Nixon on them. I now have several recordings of his staff telling me that they do in fact accept my specific insurance plan. I live in a one-party state so it's legal.
I am curious: how will the audio tapes help this case? Are you going to play them to the doctor's billing office? To the collector? At the small case court?

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2pedals
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Re: What will happen if I refuse to pay a medical bill?

Post by 2pedals » Mon Oct 02, 2017 9:07 pm

Almost positive you signed a patient responsibly form prior you receiving medical services. It will say, you are the responsible party, you are responsible if your insurance company declines to pay for any reason.

If you are refuse to pay the bill you will be in violation of the contract you have with your provider. You could be held liable to damages and to costs for collection as well. Your complaint that you were misinformed about your insurance coverage is legally irrelevant. You were informed about your responsibly to pay your bills if your insurance did not cover your services and you signed a contract stating as such.

doneat53
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Re: What will happen if I refuse to pay a medical bill?

Post by doneat53 » Mon Oct 02, 2017 9:39 pm

At 6 mo we come and take the left nad, at one year we take the right one.....

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8foot7
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Re: What will happen if I refuse to pay a medical bill?

Post by 8foot7 » Tue Oct 03, 2017 11:50 am

2pedals wrote:
Mon Oct 02, 2017 9:07 pm
Almost positive you signed a patient responsibly form prior you receiving medical services. It will say, you are the responsible party, you are responsible if your insurance company declines to pay for any reason.

If you are refuse to pay the bill you will be in violation of the contract you have with your provider. You could be held liable to damages and to costs for collection as well. Your complaint that you were misinformed about your insurance coverage is legally irrelevant. You were informed about your responsibly to pay your bills if your insurance did not cover your services and you signed a contract stating as such.
Nice try but this doesn't hold water if the doctor repeatedly misrepresented insurance choices/acceptance/status

michaeljc70
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Re: What will happen if I refuse to pay a medical bill?

Post by michaeljc70 » Tue Oct 03, 2017 11:57 am

8foot7 wrote:
Tue Oct 03, 2017 11:50 am
2pedals wrote:
Mon Oct 02, 2017 9:07 pm
Almost positive you signed a patient responsibly form prior you receiving medical services. It will say, you are the responsible party, you are responsible if your insurance company declines to pay for any reason.

If you are refuse to pay the bill you will be in violation of the contract you have with your provider. You could be held liable to damages and to costs for collection as well. Your complaint that you were misinformed about your insurance coverage is legally irrelevant. You were informed about your responsibly to pay your bills if your insurance did not cover your services and you signed a contract stating as such.
Nice try but this doesn't hold water if the doctor repeatedly misrepresented insurance choices/acceptance/status
The doctor accepted his insurance. It paid nothing. Now he has to pay the bill or suffer the consequences.

Doctors (at least none I've ever been to) don't do billing. I am not sure why you would even ask the doctor this.

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8foot7
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Re: What will happen if I refuse to pay a medical bill?

Post by 8foot7 » Tue Oct 03, 2017 12:24 pm

michaeljc70 wrote:
Tue Oct 03, 2017 11:57 am
8foot7 wrote:
Tue Oct 03, 2017 11:50 am
2pedals wrote:
Mon Oct 02, 2017 9:07 pm
Almost positive you signed a patient responsibly form prior you receiving medical services. It will say, you are the responsible party, you are responsible if your insurance company declines to pay for any reason.

If you are refuse to pay the bill you will be in violation of the contract you have with your provider. You could be held liable to damages and to costs for collection as well. Your complaint that you were misinformed about your insurance coverage is legally irrelevant. You were informed about your responsibly to pay your bills if your insurance did not cover your services and you signed a contract stating as such.
Nice try but this doesn't hold water if the doctor repeatedly misrepresented insurance choices/acceptance/status
The doctor accepted his insurance. It paid nothing. Now he has to pay the bill or suffer the consequences.

Doctors (at least none I've ever been to) don't do billing. I am not sure why you would even ask the doctor this.
You're arguing semantics, and twice in one post.
1. If his insurance paid nothing because his doctor wasn't in network after (one assumes his staff) repeatedly assured the customer otherwise, insurance was not accepted.
2. And when I say doctor, I mean "doctor's office," to include billing staff, as does just about every reasonable person.

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Re: What will happen if I refuse to pay a medical bill?

Post by rcjchicity » Tue Oct 03, 2017 12:38 pm

Although many people have questioned, the OP hasn't answered if there is a deductible that has to be met before in-network services are covered.

If that's the case, it's very well possible that the physician's office 1) accepted OP's insurance and 2) was in-network. However, in the case of a deductible, until the deductible is met, OP would be responsible for 100% of the charges before claims are covered.

Until that is known, all the rest is speculation.

michaeljc70
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Re: What will happen if I refuse to pay a medical bill?

Post by michaeljc70 » Tue Oct 03, 2017 12:46 pm

8foot7 wrote:
Tue Oct 03, 2017 12:24 pm
michaeljc70 wrote:
Tue Oct 03, 2017 11:57 am
8foot7 wrote:
Tue Oct 03, 2017 11:50 am
2pedals wrote:
Mon Oct 02, 2017 9:07 pm
Almost positive you signed a patient responsibly form prior you receiving medical services. It will say, you are the responsible party, you are responsible if your insurance company declines to pay for any reason.

If you are refuse to pay the bill you will be in violation of the contract you have with your provider. You could be held liable to damages and to costs for collection as well. Your complaint that you were misinformed about your insurance coverage is legally irrelevant. You were informed about your responsibly to pay your bills if your insurance did not cover your services and you signed a contract stating as such.
Nice try but this doesn't hold water if the doctor repeatedly misrepresented insurance choices/acceptance/status
The doctor accepted his insurance. It paid nothing. Now he has to pay the bill or suffer the consequences.

Doctors (at least none I've ever been to) don't do billing. I am not sure why you would even ask the doctor this.
You're arguing semantics, and twice in one post.
1. If his insurance paid nothing because his doctor wasn't in network after (one assumes his staff) repeatedly assured the customer otherwise, insurance was not accepted.
2. And when I say doctor, I mean "doctor's office," to include billing staff, as does just about every reasonable person.
I don't view it as "semantics" when two terms mean different things and produce different results. He didn't ask if the doctor was in network. That is what he should have asked. And it would have been much better to call the insurance company or look on their website. Doctor office staff don't know every insurance policy and network off the top of their heads and would need to know your particular plan and look it up. Did he say "I have the BCBS plan XYZ that uses the ABC network?"

Sachay
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Re: What will happen if I refuse to pay a medical bill?

Post by Sachay » Tue Oct 03, 2017 12:53 pm

Pay the bill and sort it out later.

I know what happens if you do not pay. You get sent to collections and it will go on your credit and cause you problems if you need to use your credit.

I also felt I was 100% in the right- I was injured at work, and I worked for a hospital, the same hospital's ED where I was treated during work hours and assured this was covered by work in writing, both at the time and in my benefits documents and in my onboarding materials. I was young and could not get credit cards with more than a $300 limit for many years. I followed all the dispute processes and nothing worked. I had a letter stating it was a mistake sent to all 3 credit bureaus. I eventually had to take a loan I did not need. I still can not get automatically approved for a card with my credit above 800, and this "fell off" a long time ago.

This was over $35 dollars. But I was right! Someone did eventually reimburse me the $35.

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