Can a care provider charge me for the urgent care visit as out of network if the facility has a contract with my insurer?

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Can a care provider charge me for the urgent care visit as out of network if the facility has a contract with my insurer?

I fractured my hand on Friday night and had no choice but to visit an urgent care unit on the following Saturday. I asked the secretary if they are taking my insurance and whether they are in my network and she reassured me everything should be fine. Few weeks later I get a bill for a couple hundreds dollars for the services rendered by one of the doctors since that doctor is not in my network. While X-rays are done under a different name and are in-network? Can they do this? How can I prevent things like this from happening?

Asked on July 7, 2012 under Insurance Law, California

Answers:

FreeAdvice Contributing Attorney / FreeAdvice Contributing Attorney

Answered 9 years ago | Contributor

It is entirely possible for a health care provider to charge a patient for urgent care visits as out of care when the patient is not in the network for the health care services.

As to being charged by this health care provider for services if that patient's insurance is accepted by the health care provider then under the terms and conditions of the contract between the health care provider and the insurance carrier the patient should not have to pay the full rate for services. Rather, any co-pay and applicable deductible should apply.

If I were you, I would contact the representative for your health care insurance company over what transpired over the recent charges you received for the x-rays that you have written about and protest the charges.

MD, Member, California Bar / FreeAdvice Contributing Attorney

Answered 9 years ago | Contributor

You need to speak immediately with the director or administrator and file a complaint with the medical board and department of insurance because you were informed all were in network. This should help.

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