What your doctor’s office doesn’t know could hurt you!

Has this ever happened to you?

You sign up for new insurance online and you pick a plan that you think is great because the price is right and all the copays are low, then you get a huge bill from your doctor’s office saying that the insurance did not pay.  What gives?

I recently talked to someone who was told by a customer service agent on the “Obamacare” Healthcare.gov helpline to call her doctor’s office to find out if they accept the insurance.

“This is a big mistake.”

Often times the staff at your doctor’s office sees many different insurance cards.  They may see a card from the company who has the plan that you chose and it will sound familiar to them so they may say, “Yes, we accept that insurance.”

The problem is that your new plan may be an HMO (Health Maintenance Organization) and if that’s the case, this plan has a network of doctors that will accept the insurance.  Any doctor not participating in this network will not accept the plan.

What’s the problem if they say they accept it?

The problem is that they may not know it’s an HMO plan.   See, there are many different types of plans and some are PPO (Preferred Provider Organization) plans.  These PPO plans have coverage for out-of-network doctors (usually at higher rates.)

Read more about the differences between HMO, PPO and other plans here.

So, if someone has a PPO plan with the same insurance company then they could see any doctor because it covers doctors visits whether they are IN or OUT of the network.  The staff at your doctor’s office may have seen people with cards from this insurance company so the staff at your doctor’s office might have the impression that they accept ALL plans from this company which may not be the case.   If your doctor is not in your new plan’s network then your new HMO plan will not pay the bill and you will either have to find a new doctor or pay the bill on your own.

How can you be sure your doctor accepts your new insurance plan?

Work with an agent or call the insurance companies directly before you sign up for any plan and make sure all your doctors, hospitals and Medications are covered by the insurance.   This is why I believe everyone should work with an insurance agent when shopping for health insurance.  I look at the overall costs associated with the plan when I meet with a new client.  We check to make sure any doctors or services you need are covered by the new plan before we enroll.  And we make sure to check to see if all prescription medications are covered because each of the plans covers medications differently.