Me and my husband have independant insurance. We pay 300.00 a month and that is with maternity. Now the doctor says we have to pay the entire doctor bill before May so that is 500.00 a month. They said they don't know if our insurance is going to cover the doctor bills or the hospital bills when the baby comes so we have to pay up front and if the insurance pays them, they will pay us back and if not, they will already be paid off. Can they do that? Why wouldn't they just bill the insurance so they can get their money from them? That is why we have insurance.
2007-11-29 09:20:22 · 8 answers · asked by Baby Girl Rylin 5/3/08 4 in Business & Finance ➔ Insurance
Is there a reason the doctor might suspect that the insurance company wouldn't cover your bills?
Given that you say you have "independent" insurance, which I presume to mean not through an employer, perhaps the doctor's office is a little skittish...thinking that you may not have a maternity rider and/or that your insurance won't still be in effect by the time you deliver.
Do you have a PPO plan, and if so, is your doctor a provider in that plan's network? If so, you may want to contact your insurer's customer service. Many contracts between PPOs and physicians do require the doctor to bill the insurance company. Find out if your doctor has a contractual obligation to bill the insurance company before they bill you.
Note - if the doctor's contract with your insurance company doesn't specifically state that they have to bill insurance first *or* if your doctor doesn't have a contract with them at all, that wouldn't apply of course. Your doctor could bill you for whatever portion of the charges they wanted whenever they wanted.
2007-11-29 11:43:51 · answer #1 · answered by sarah314 6 · 0⤊ 0⤋
Did you check with Independent Insurance to see what doctors honor their insurance?
Have you contacted Independent to find out what is covered and what is not most insurance companies will supply this information and then you can just agree to pay the uncovered amount.
Yes they can make you pay in advance infact that is the norm for pregnancy but the doctor usually knows how much the insurance will cover so you only have to pay the difference up front.
2007-11-29 09:30:17 · answer #2 · answered by Space493 3 · 1⤊ 0⤋
it sounds like the provider you are seeing is not contracted with your insurer. if your provider is asking for funds up front, this is what it sounds like and he is not required to submit clams .
call the member services number listed on your id card. member services is extremely helpful and will be able to give you exact information since they have your benefits right there. they will be able to tell you if your doctor is contracted or not and will be able to work with the provider as far as pre-approval on the delivery.
you will want to know at what level your benefits will be paid because if your doctor is not contracted you WILL be balance billed for any fees over what your insurer pays ( ex. insurance company will pay 70% of the fees based on their scheduled rate of $100, your provider charges $200. you will be required to pay the 30% of the $100 plus the $100 that isn't covered).
hope this helps
2007-11-29 10:36:35 · answer #3 · answered by kittie_in_ca 3 · 0⤊ 0⤋
Yes, they can. They aren't required to bill the insurance company, and they aren't required to submit any claims.
Some providers do NOT bill insurance companies. It's a hassle, and it's not like they get paid any extra for the extra service.
Your deal with your doctor is between you and them. Your deal with the insurance is between you and the insurance company. If you don't like the way your provider is doing it, you can switch to a new doctor, that WILL bill your insurance company.
2007-11-29 10:35:43 · answer #4 · answered by Anonymous 7 · 0⤊ 0⤋
Man you guys have it rough in the US when it comes to medical.....
Thank goodness the Liberal government here was just tossed out on their collective rear ends. Now with a Labour government we will stop heading the same way as the US in our hospital system & no one will have to think twice about going to see a doctor because they don't have insurance!
2007-11-29 09:35:42 · answer #5 · answered by Anonymous · 0⤊ 0⤋
That is very common. Many ER doctors are self employed and charge separately from the hospital. No different from happens with most surgeons.
2016-05-26 22:32:30 · answer #6 · answered by ? 3 · 0⤊ 0⤋
The doctor can do so, if he wishes. Your option is to seek out another doctor. There are no laws preventing what this doctor is doing. And my guess is that he is doing it because he's been burned one too many times in the past.
2007-11-29 10:54:59 · answer #7 · answered by acermill 7 · 0⤊ 0⤋
talk to your insurance representative.
Do not pay anything until you know what is covered.
2007-11-29 09:29:50 · answer #8 · answered by Brad456 5 · 1⤊ 0⤋