Helping to prevent pitfalls for others

[quincy]

It takes two to tango and I'm sorry for my part in causing the misunderstanding.

I appreciate the links you provided. Thank you!

Code 790.03.h(7): "Attempting to settle a claim by an insured for less than the amount to which a reasonable person would have believed he or she was entitled by reference to written or printed advertising material accompanying or made part of an application."

Is not the intent/design of the insurance company's website to advertise greater choice of doctors in close proximities to attract members? Is it the duty of a "reasonable person" to look through the fine print and see the omission of the location of an in-network facility? Or is it the duty of the advertiser to make obvious (not just in the fine print) that the doctor is only in-network at the specified locations?

Thanks again.

It generally falls on the consumer to read the fine print. With advertising, however, a consumer needs to at least be given the fine print to read.

 

[ConsumerAdvocate]

Additionally, we were assured by the admitting clerk of the in-network, doctor-owned facility (with said owner-doctor being in-network and the primary doctor performing the procedure), that the auxiliary doctor is also in-network. Yet, despite the clerk's assurance and despite this auxiliary doctor being advertised as in-network on the insurance website, because the address of the in-network facility was omitted on his advertising page, he is considered out-of-network at the doctor-owned, in-network facility that contracted him in.

Like independent-contractor barbers or beauticians who rent their space and tools in shared facilities to practice their profession, what's to stop doctors from doing the same with said "rent" supporting a generous kickback from four-times the rate from out-of-network billing?

Thank you.

 

[quincy]

Additionally, we were assured by the admitting clerk of the in-network, doctor-owned facility (with said owner-doctor being in-network and the primary doctor performing the procedure), that the auxiliary doctor is also in-network. Yet, despite the clerk's assurance and despite this auxiliary doctor being advertised as in-network on the insurance website, because the address of the in-network facility was omitted on his advertising page, he is considered out-of-network at the doctor-owned, in-network facility that contracted him in.

Like independent-contractor barbers or beauticians who rent their space and tools in shared facilities to practice their profession, what's to stop doctors from doing the same with said "rent" supporting a generous kickback from four-times the rate from out-of-network billing?

Thank you.

I suggest you file a complaint and see if there are any changes made to the website.

Good luck.

 

[cbg]

Look, you obviously won't be satisfied until someone tells you what you want to hear. You want to file a complaint? File a complaint Maybe they'll change the website, maybe they won't.

But since they've already done more than the law requires them to do and you've been made whole, you've got no lawsuit and no legal action available to you.

 

[ConsumerAdvocate]

I suggest you file a complaint and see if there are any changes made to the website.

Good luck.

Thank you.