Flabbergasted? Doctors And Prescriptions Can Fall Off Your Plan

It is readily acknowledged that medical services billing and insurance coverage is a complex path to walk. insurance companies should effectively communicate their coverage capabilities, but not only is this difficult for the insured, it can also be a mystery to the physicians billing services. The doctor is covered but certain tests are not fully covered. The coverage for prescriptions is random. The insurance companies can even decide that a doctor is no longer covered under their program, though they have been for the last ten years. Though they are required to tell all the persons involved, this information can be lost in the endless insurance paper chain, leaving the confused doctors and patients to decipher what happened when and where, and what is owed to who.

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Clay had been seeing his doctor for five years. Together they had helped Clay. Albuterol, an inhaler for short-term symptoms was used. When his lung function began to decrease, [another steroid breather, Advair was added. When Clay had an unexpected attack, an emergency room visit was necessary. As a standard, all of these services were, paid in full by the insurance provider. Two months later when Clay returned to his doctor for a check-up and to get his prescription refilled, Clay was was surprised when he was informed that the Advair he was required to take for the rest of his life was now going to cost him one hundred dollars every two months.

When Clay informed his provider, he was told that Advair was no longer covered under his plan. He said that he had tried other steroid inhalers, but they were ineffective. They said that this was not their problem. He and his doctor would have to find another drug. Three months later, Clay also received a bill for the entire payment of his treatment and lab tests at the previous doctor’s visit. He called the doctor’s office and was informed that his primary care practitioner was also no longer covered under his insurance. When he called the insurance company to complain, their response was that doctors were shifted from time to time and it was up to the medical provider to make sure that you knew that the visit was not covered. When Clay called the billing office he was told, that because he was a long time patient they didn’t ask for the money up front, but as a courtesy, sent him a bill in the mail.

Clay struggled with the insurance provider for years with no result. In the interim, he acquired a bad credit rating because his bill went to collections since he refused to pay it.. The doctor also went unpaid for Clay’s visit, as well as the loss of a good patient. More work had to be done by the billing company, not to mention the stress of dealing with a disgruntled patient. The ones who didn’t suffer were the ones who were never confused and that was the insurance company.