Oral office said "yes" they were part of our insurance plan and now I find out they're not. Are we liable?

Question

My son needed wisdom teeth removed and I called the oral office who said "yes they were part of our plan". However, after insurance paid them, comes to find out they are not. If they were, 20% would have been written off by insurance and we would owe them about $360, $300 has been paid upfront. Now they want $490. What can I do? Thanks!

So nothing? I can't win? Even though I specifically asked the oral office? Isn't there some where I can report them?

Answer 1

Unfortunately, as far as your insurance company is concerned, it is YOUR responsibility to verify directly with the insurer whether any provider is part of the network. I always tell everyone not to take the doctor's offices word for it, because doctor's offices can make mistakes (no matter how good their intentions are). And you're the one who would be financially liable if a mistake was made, so its always in your best interests to check yourself.

Since you're talking about wisdom teeth and oral surgery, I wouldn't be surprised if the following happened: the oral surgeon's office may be part of your dental network, but the wisdom teeth removal fell under your medical benefits and the oral surgeon isn't part of that network (or vice versa). And the oral surgeon's office made an innocent mistake due to that, or some similar scenario.

You could always try to negotiate with the oral surgeon's office since they made the mistake, but there's no guarantee that it will work. And, unfortunately, they are within their rights to collect the amount as processed by your insurance company.

I'm sure you know this now, but just in case...always, always, always verify the network status of your physicians directly with your insurer. Don't just take someone else's word for it.

Answer 2

All of these answers are right, be happy it was not a huge expense on a major surgery and this happened...

Just vent your anger on them. Here is arkansas one of our new stations will investigate things like this and help you get restitution while silmutaneously informing the public of the flaw and how to protect themselves. See if a news station will take on the publicity case, generally when a business starts to get TRUE bad press they want to resolve the issue so it doesn't hurt their business. It is not a great expense but it a couple hundred can make a difference to some families.

I had this a happen once but I was a long time patron since child hood and they were happy to admit mistake and void the bill.

Good luck...

Answer 3

There's probably nothing you can do except to vent your anger.
This has happened to me on the medical side when I took the word of the medical front desk receptionist that a doctor was within my provider network only to find out he wasn't. I have learned to verify with the insurers that a specific provider is a member of their plan and not take anyone's verbal word.

Answer 4

Sorry, the insured is responsible for knowing their benefits. Never call the provider. Always call the insurance company. The provider is searching for business. The insurance company already has yours, and are more likely to give you the most accurate information.
This is an expensive lesson for you, I would change providers for sure after this and do my homework.

Answer 5

You can pay the balance of the charges for the services rendered. It's entirely possible that the oral surgeon WAS, at one time, part of your network, and information was not updated.

Nonetheless, it's your responsibility to check with the insurer ahead of time to get a list of oral surgeons who operate under the network and its agreements.

Answer 6

Nothing. Ultimately, the responsibility is YOURS to call your insurance company, and ask if that particular provider is in network.

You're liable for the money, for services that were rendered. Sorry.