Jew Make the Call: Doctor's Office/Insurance Edition

[Dan Druff]

Scene:

You have a non-urgent issue with unknown pain in your eye, so you schedule a visit an ophthalmologist. You have never been to this doctor before. Your eye is only in moderate pain, vision is normal, and you are not worried about any long-term damage. You just would like to see someone about it in the next week or so.

The office tells you to e-mail them your insurance info in advance, and also to fill out some paperwork, scan it, and e-mail them that as well. You are told to do this so they can "verify that your insurance is taken and the visit is covered" prior to going. Obviously this sounds like a good idea, so you do it. The office manager responds to your e-mail that they've received everything. Your appointment is in 3 days, on a Friday at 4:40pm. You did not choose this appointment time -- it's simply the only time they can see you this week.

You show up to your appointment, and after waiting for about 20 minutes, they give you the bad news.

"We can't verify your insurance," says the office manager. "Apparently they close at 4:30."

Indeed, to your surprise, your insurance's customer service department closes at 4:30pm PST -- something you didn't previously know.

Then you remember that you submitted your paperwork to this office 3 days ago, so they could verify it then! Why is this happening now? Why didn't they already verify it, and call you with any issue?

You ask the office manager this question. She sheepishly admits, "We meant to do this, but accidentally put your paperwork aside and forgot to check on your insurance. When you showed up for your appointment now, we realized we hadn't done it yet, but your insurance is closed."

You ask the office manager, "Well, okay, but shouldn't you know if you take my type of insurance?"

"Oh, we do," she says. "But we have to verify that you're still enrolled and everything is valid."

You then ask what they're asking for you to do at this point.

"We are going to have to ask you to put up $150 in advance for this visit, which is our non-insurance rate. If we can verify with your insurance on Monday that you are really enrolled, then we will refund the difference to you." (Your co-pay is $30.)

"That's the only option? You can't just assume that my insurance is good, since it was you guys who forgot to check it? I mean, here's a valid card I'm holding right here. Look at it...", you reply

"I'm sorry," she says. "You either need to pay us the $150 in advance, or we can reschedule you to next week."

"But this whole thing was due to your office forgetting to check my insurance in advance. This is only an office visit. I'm not here for any kind of expensive test or procedure. Can't you just have the doctor see me?"

"We can't do that, I'm sorry. That's policy," she coldly tells you.

"How about you take a copy of my credit card, but agree to only charge it on Monday in the case that the insurance isn't valid? I'll be glad to sign a paper authorizing that."

"We can't do that," she says. "Once again, either pay the $150 now, or you can reschedule."


What do you do? For your information, this is a small office, and the office manager is the doctor's wife. There are several other ophthalmologists in the area, all of whom are unaffiliated with this doctor.

Answer poll above.

[blake]

this is an awful doctor. i've never heard of something like this. usually doctors will charge you the copay amount and then note that you're responsible in the event insurance doesn't cover it. but making you pay the whole amount up front? that's unheard of in my experience

edit to note i would have paid it only to save myself some inconvenience and it wasn't that much money

[Salty_Aus]

Scene:

You have a non-urgent issue with unknown pain in your eye, so you schedule a visit an ophthalmologist. You have never been to this doctor before. Your eye is only in moderate pain, vision is normal, and you are not worried about any long-term damage. You just would like to see someone about it in the next week or so.

The office tells you to e-mail them your insurance info in advance, and also to fill out some paperwork, scan it, and e-mail them that as well. You are told to do this so they can "verify that your insurance is taken and the visit is covered" prior to going. Obviously this sounds like a good idea, so you do it. The office manager responds to your e-mail that they've received everything. Your appointment is in 3 days, on a Friday at 4:40pm. You did not choose this appointment time -- it's simply the only time they can see you this week.

You show up to your appointment, and after waiting for about 20 minutes, they give you the bad news.

"We can't verify your insurance," says the office manager. "Apparently they close at 4:30."

Indeed, to your surprise, your insurance's customer service department closes at 4:30pm PST -- something you didn't previously know.

Then you remember that you submitted your paperwork to this office 3 days ago, so they could verify it then! Why is this happening now? Why didn't they already verify it, and call you with any issue?

You ask the office manager this question. She sheepishly admits, "We meant to do this, but accidentally put your paperwork aside and forgot to check on your insurance. When you showed up for your appointment now, we realized we hadn't done it yet, but your insurance is closed."

You ask the office manager, "Well, okay, but shouldn't you know if you take my type of insurance?"

"Oh, we do," she says. "But we have to verify that you're still enrolled and everything is valid."

You then ask what they're asking for you to do at this point.

"We are going to have to ask you to put up $150 in advance for this visit, which is our non-insurance rate. If we can verify with your insurance on Monday that you are really enrolled, then we will refund the difference to you." (Your co-pay is $30.)

"That's the only option? You can't just assume that my insurance is good, since it was you guys who forgot to check it? I mean, here's a valid card I'm holding right here. Look at it...", you reply

"I'm sorry," she says. "You either need to pay us the $150 in advance, or we can reschedule you to next week."

"But this whole thing was due to your office forgetting to check my insurance in advance. This is only an office visit. I'm not here for any kind of expensive test or procedure. Can't you just have the doctor see me?"

"We can't do that, I'm sorry. That's policy," she coldly tells you.

"How about you take a copy of my credit card, but agree to only charge it on Monday in the case that the insurance isn't valid? I'll be glad to sign a paper authorizing that."

"We can't do that," she says. "Once again, either pay the $150 now, or you can reschedule."


What do you do? For your information, this is a small office, and the office manager is the doctor's wife. There are several other ophthalmologists in the area, all of whom are unaffiliated with this doctor.

Answer poll above.

Reschedule and give them an invoice for $150 for wasting your time.

[Gordman]

This is pretty shitty service. If there are other docs in the area, I'd visit one of those and tell these guys to fuck off. If they are this incompetent from the get go, who knows what else is in store for you.

And like Blake said, the proper thing to do would be to charge the copay and let the customer know that they are responsible for the rest if it if insurance doesn't cover it.

[Cerveza Fria]

Most insurance companies have electronic verification systems in place for providers to use. This means that they can verify insurance 24 hours a day with the swipe of card or entry of some keystrokes. Your provider should be aware of this.

There is another option: Pay via credit card and do a Credit Card dispute if they do not refund the difference.

[simpdog]

I picked pay now and trust them.

Only because I want to see the fallout.

[JoeD]

Tylenol and a bag of frozen vegetables used as an ice pack.

You're welcome.