Is the staff at Dr's office getting lazy?

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   OhDeerposted 10 years ago

   Have you ever hit a stonewall between the doctor's office and your insurance company when trying to get a procedure authorized? I wrote my story after diagnosed with cancer about it recently when needed a PET scan and doctor's office manger seemed to be certain that my insurance did not authorize it..
   <link snipped>

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      wildernessposted 10 years agoin reply to this

      They probably know more about your plan than you do. 
      
      In any case, it is your life, your body and your bill.  No one else is responsible for paying it; if you think the insurance company should cover it take it up with them.  It is not the doctor's responsibility to see that your insurance company meets its obligations to you, and that company has NO obligations to the doctor at all.  You do.

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         psycheskinnerposted 10 years agoin reply to this

         Um.  That is what the hub says, actually.
         
         But actually I think it is in fact the doctor's responsibility to pursue getting their patient treated, including checking with the insurance company rather than just assuming they won't cover a critical test.  I walk away from doctors who are passive like this because what else will they stand by and let kill you, perhaps while you are in a debilitated state?  The doctor should be their patient's advocate, that is in fact something they swear to do when they are licensed.  I changed doctors until I found one actually willing to be proactive in keeping me alive and healthy.

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            wildernessposted 10 years agoin reply to this

            Yes, it is their duty.  Didn't read the hub, but assumed (wongly?) that they asked and were told no.  At that point, seems to me, it is the patients duty to take a part rather than stand back and ask the doctor to do it all.
            
            The only time I've had a problem was when the insurance company refused an anesthesia bill; it was way too much and they required the transcript of the surgery.  It ended up that I told the doctor I wouldn't pay until the insurance company actually got that transcript.  It was sent to collections and the doctor told me 3 times they sent it (including once while the insurance company was on one line and the doctor's office on the other but no fax was received) before they finally broke down and sent it.  They flat refused to give it to me to deliver, and I've always wondered what went wrong to triple that part of the bill but never found out.
            
            The point is, though, that it was MY bill and MY responsibility to get it paid.  Not the insurance companies - the only hold I had was that it was far too high and the doctor refused to say why.  That put it back on the doctor and as it would have come out in court anyway he finally caved in.  In this case, the insurance company was reasonable and helpful (they promptly paid when they got the information) and the doctor was the one holding up the process.

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               psycheskinnerposted 10 years agoin reply to this

               I think if you will read the hub it is about OP doing exactly that--very diligently. And it was not just about getting it paid, but getting a crucial test for cancer done at all.

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                  wildernessposted 10 years agoin reply to this

                  Then it seems quite possible that it isn't covered.  Not the doctor's fault, not the insurance companies, and probably not even the patient's (how many of us actually know or understand what our policy says?), but the cost still belongs to the patient, not the doctor and not the insurance company.
                  
                  Having said that, I fully understand that many (most?) companies will drag their feet on paying high bills and will resort to all sorts of chicanery to avoid it, up to and including waiting until the patient dies before rendering an OK to go ahead.  And the doctor is the only real resort the patient has and does have a duty to try and help.

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                     psycheskinnerposted 10 years agoin reply to this

                     As the hub explains, it was covered--the doctor was wrong.
                     
                     As the hub explains this was about getting approval to even do the test.  The don't do PET's based on an IOU.
                     
                     To critique the message of the hub it is a good idea to read the hub.

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                        wildernessposted 10 years agoin reply to this

                        Very seldom read hubs that are posted in the forums.
                        
                        *edit* And now I see the link was snipped anyway.

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                           psycheskinnerposted 10 years agoin reply to this

                           Quite natural given that it is basically spam, but that does mean you didn't actually know what OP was promoting.

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                              wildernessposted 10 years agoin reply to this

                              You're right, it sounds like I didn't.

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