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anyone here work for an insurance company? health insurance

post #1 of 3
Thread Starter 
i need to know if a doctor who is signed up with an insurance company (what do they call that? enrolled? an enrolled provider?)
well, what i need to know is, if a doctor is accepting say, XYZ insurance
and he decided he doesn't want to accept that insurance any more,
can he dis-enroll/leave the company and BACKDATE the dis-enrollment??

i know this must sound bizarre, why would a doctor want to do this, but this is exactly what i was just told that my doctor did

leaving ME stuck with bills back to Oct of last year. Unless he calls and decided to back date this even more, who knows?

and if he can do this, i am guessing any doctor can- so if you have insurance, well, maybe you really DON'T have insurance, because the doctor can leave the program at will, at any time, and even back date it...

this sounds horribly unethical, but is it legal?
post #2 of 3
Call your insurance company and talk to them. They should have everything on file, including the date when the bills were originally sent to them. If you still have receipts from any copays that could be useful, too.
The other possiblity is that your insurance was trying to get out of paying their part.

I hope you can get this straightened out, that doctor's trick sounds very underhanded.
post #3 of 3
Having developed a good relationship with a doctor, I can understand why some would choose to end their relationship with an insurance company. In my instance, it was with a physical therapist. Any appointment with her ranged from 1/2 hour (shortest I ever had was closer to 45 minutes) to 1-1/2 hours. Her normal billing rate would be $150/session - regardless of how long it took. Some insurance companies paid a percentage, while others paid her anywhere from $48 for each session. Considering she obviously has an office, a receptionist, insurance, as well as paying herself a living wage, $48, she said, doesn't even cover her overhead.

Yes, it completely SUCKS that your doctor did that to you. They should have informed all of their patients at the earliest opportunity, and all things being fair (which of course they usually aren't) you shouldn't have to pay back charges. That's just ridiculous!

I would definitely call your insurance company and find out as much as you can about your situation and if he can legally do that to you.
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