Should I have to pay this pediatrician's bill?

Question

When I was pregnant, I called the pediatrician's office and asked if they accept my insurance, and they told me that they do. I met the pediatrician a month later, and then a month after that my son was born (November 25). The pediatrician came and looked at my son when he was born, and then after about 4 doctor's visits, I learned that my health insurance company is not part of their network, leaving me with a $300 bill. I called the doctor's office and told them that I would accept responsibility for that bill, but that I would need to find a new doctor that does accept my insurance. She told me that she would try to become part of the network, and not to worry about paying anything. The baby has seen the doctor several times since then, and every time I bring him to the doctor, she just says "they haven't gotten back to me yet". Now I am getting a bill from the doctor saying I owe them $1000. I intend to get a new doctor for my son, but should I be forced to pay that bill?

Answer 1

I agree with "Mr. Taco" on this one. This involves a legal doctrine known as "promissory estoppel." Because the doctor's office made promises to you, it may be barred from collecting anything other than the co-pays you would have owed. You acted based on their promises and you are now damaged financially. This is referred to as "detrimental reliance." However, I also believe you had the obligation to confirm the doctor's participation status with the insurer prior to giving birth, to ensure the doctor was a participating provider. The doctor may raise this as a defense. Ultimately, a judge will have to decide what percentage of blame rests on you and what rests on the doctor's office.

You should speak with the DOCTOR, not the office manager. If s/he doesn't offer to excuse the bill, I suggest you consult an attorney.

Answer 2

Well, yes. And just because they "become" part of the network, doesn't mean that the PAST bill will become an "in network" bill - it won't.

So yes, you're obligated to pay. His billing department will eventually bring you through collections - and win. You had the services.

I just don't understand why you keep bringing the baby back, when you KNOW it's not in network. Switch TODAY. It can take 6 months for a doctor to be in network, and it might not go into EFFECT for another six months, and it might never happen!! Regardless, PAST out of network services will NOT be converted.

You need to verify with the INSURANCE company, if someone is in network or not - NOT the service provider. Or rather it doesn't HURT to call and ask the provider, but they BOTH have to agree with each other!

Answer 3

I would ask to speak to the office manager and tell them of this series of conversations and bills. I know that they can discount their services and they probably will if you come to them willing to work with them. I am betting the doctor is unaware of this situation and would croak if they knew about it. If you go about it in a nice way, I believe they will help you. Getting in network with an insurance company can be a long process, so if your baby has to see a pediatrician very frequently, I'd get another one for the time being. Good luck!

Answer 4

Almost always before. Sometimes they will work out payment arrangements if you discuss it w/ them in advance. Even if you do not qualify for medicaid at this time, you might in 3 months. Even though you don't qualify for assistance, you should still be able to get the shots for free through your local health department, that is how it worked w/ my son when he was a baby. Try calling them, it may be different in your state. The health dept should have some other suggestions too. If not, and you do have to pay for the shots cash, I suggest comparing the price between your doctor and one of the Walgreens walk in clinics.

Answer 5

Legally, you kind of do - at least the $300 - because that was before the issue came to light. (Technically, it is your responsibility as a patient to make sure any providers are in your specific network) HOWEVER, if after you told them you were going to change doctors and they told you to wait to see if they could become part of the network and they couldn't become part of it, then technically, they should eat a portion of that bill (i.e. discount it) - since it was their oversight. You should have to pay some of it because you could have forced the change issue and told them you'd come back to them if they become part of your network.

Answer 6

Sorry, but you're going to need an attorney for this one. There are a lot of factors that you don't discuss here that would make the difference, and what state you live in will matter, too. I will say this: it is probably worth at least getting a consultation with an attorney. Good luck!