is this even legal?

[sullidog]

I put this thread here because it's not exactly dialysis related, but it's general healthcare related.
Some of you may have been in this situation before. Anyways, my PCP does not do her own hospital rounds, and from what I understand a lot of them don't for whatever reason, so whenever I'm in the hospital they have another PCP come in for inpatient services. The last time I was in the hospital and after I was discharged turns out the PCP that came to see me was not even on my insurance plan so therefore the insurance didn't pay, and so I got stuck with paying all of it out of pocket. Is this even legal for them to have a PCP come see me that isn't part of my insurance plan? Why would they do such a thing? How do I make sure in the future I'm given a PCP that is in my plan?
This is very frustrating as I had to pay all the bills from this doctor. I don't think it's fair for the patient.

[Desert Dancer]

Yeah, I think it happens to everyone. The hospitals have their PCPs who do all their inpatient care. It's not something people tend to think about when they're in the hospital; doctors just come in and out and you talk to them all and then discover later they're not on your insurance.

I think if I'm ever in the hospital again I've got to remember to check everyone at the door by saying, "If you're not on my insurance plan then turn right around and leave." They can't MAKE you talk to them, though they'll probably still bill you anyway just for handling your chart.

What's really bad is when you discover after the fact that an anesthesiologist isn't on your plan! 

[cariad]

Talk to your insurance!

We went through this a few years ago in SoCal when Gwyn was really sick and needed to go to the ER. The ER doctor was not on our insurance. I had to chase up all sorts of information, but when I told my insurance company about it and asked if this was going to be resolved, the man told me that he takes at least one call a day along these lines, but he rarely takes a call from someone who has disputed the claim rejection. The decision was made by your clinic, not you, so you should argue that to your insurance.

DD, my transplant anaesthesiologist was not on Medicare. (Why on earth is he let near transplant patients, then??) It is just a load of bureaucratic garbage, in the end it was sorted and I did not have to pay him the, I don't know, 20 grand? It's annoying, though. Good luck, sullidog

[lmunchkin]

The hospital where J goes assigns a case manager. Anything and everything is done through this case manager.  They had doctors who were called "Hospitalists Physicians" but they followed the derectives of your Primary doctor.  But the case manager was over the coordination of insurance and approvals. He/she was responsible for the payments of the services given. Most of the time, a case manager is constantly on the phone with Insurance company's.  Talk about a HEAD ACHE JOB!!!!

lmunchkin

 

[kporter85db]

I think I would pay this doctor 5 bucks a month for the next 40 years. This is a crazy practice!

[sullidog]

Yeah and I even have two insurances! crazy!

[Katonsdad]

I am waiting for a bill right now as I received a notice from the insurannce (and a 68 dollar chck for their portion)
I called zand asked as the total bill was $204 and the ins said that it was a non particpating doctor.  Well I am going to offer them the ^8 dollar check as payment in full as that is what my ins, allows.(and sent me a check for)
After that he can east sour apples.
Katonsdad