Doctor said in-network but it was out of network, and ask me to pay

Asked about 1 year ago - New York, NY

The doctor's office told me they are in-network of my insurance. Then they charged a lot and sent me a bill and indicate it was out of network so I need to pay. Do I need to pay? I would not have used the doctor if I knew it was out of network.

Attorney answers (2)

  1. Warren Jeffrey Roth

    Contributor Level 11

    2

    Lawyers agree

    Answered . The first thing you should do is contact your insurance company and confirm whether or not the doctor is in network. If he or she is out of network find out from the insurance company how much of the bill they are willing to pay under the circumstances. If this does not get the bill resolved then I would seek out a consultation with an attorney.

    THESE COMMENTS ARE NOT LEGAL ADVICE. They are provided for informational purposes only. Actual legal advice can only be provided after consultation by an attorney licensed in your jurisdiction. Answering this question does not create an attorney-client relationship or otherwise require further consultation.

    COMMENTS ARE NOT LEGAL ADVICE. They are provided for informational purposes only. Actual legal advice can only be... more
  2. Kimberly A Howland

    Contributor Level 8

    2

    Lawyers agree

    Answered . Generally, you as the insurance policy holder are responsible for knowing which physicians are in or out of your particular insurance policy network. If you do not have a manual/book provided to you from your insurer that lists in-network physicians, you should call your insurer to confirm the status of as particular physician that you wish to receive service from.

    At the time of the visit with the physician you may have signed an authorization to bill your insurance company that included acknowledgment that you are responsible for all payment whether or not covered by insurance. In this event, the physician has every right to seek payment from you.

    It may be possible to work out an arrangement with the physician's office for monthly or reduced payment as a result of the confusion.

    My concern is that you likely have nothing in writing from the physician office telling you that they are in network and so cannot show they told you that.

    Also, it may be that there is confusion between the insurance company and the physician office and that the physician office or physician actually is in network. If you have not done so already, you can call your insurance company and review it with them.

    If you cannot clear this up yourself, then I do suggest contacting an attorney who specializes in health law.

    The information provided is general in nature and is not meant to be legal advice or counsel. It is not specific... more

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