How many times did you get a surprise bill from your doctor asking for money that your insurance company refused to cover due some technical mambo jumbo and jargon. Take these steps every time you want to visit a doctor or have a medical procedure.
Yes, CALL your insurance company to verify that the doctor you are planning to use is part of the insurance company’s network of preferred provider. Most likely insurance company’s website is not up to date, so make sure to make that call. It is also advisable to call your doctor’s office and ask for the Tax ID they are using to bill your insurance company. Use that Tax ID to verify if your doctor is part of your insurance company’s preferred network of providers.
When you make that call with your insurance company, ask for a Reference Number at the end of the call since most insurance companies track their insured call and some even record it. Use that reference number to dispute any charges that are different from what you were told.
Key Take away: Call your doctor, ask for his/her Tax ID. Use that Tax ID to verify with your insurance company if your doctor is part of the insurance company's network.
You go to your doctor, and he/she refers you to do specific procedure like x Rays, CT scan, etc. After you do that procedure, you discover that it is not covered or partially covered for many reasons like you did not get a pre-authorization, or you the doctor performing the procedure is not part of the insurance company’s preferred network, or the facility where the procedure is performed is not part of the network. You need to take the following steps to reduce the possibility of getting a surprise bill:
Key Take away: Call your doctor, ask for his/her Tax ID. Use that Tax ID to verify with your insurance company if your doctor is part of the insurance company's network. Ask for CPT Code for the procedure to be performed. Make sure the doctor performing the procedure and the facility used are all part of the network. Make sure you understand how the facility is designated by the insurance company as a standalone facility or part of a specific hospital.
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