What can we do if my husband needed an eye doctor and our insurer told us that XYZ was in-network but failed to tell us that the doctors were not?

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What can we do if my husband needed an eye doctor and our insurer told us that XYZ was in-network but failed to tell us that the doctors were not?

Our insurer told us that XYZ was in network, so I called XYZ gave them my husband’s insurance information. They stated that they were in-network and gave us an appointment for doctor ABC in their office. My husband went to the appointment and had surgery with doctor ABC. I then got a call from the billing department stating that I needed to paid $6,727 in order for the doctor to finish the surgery on the other eye. I asked how this was possible and the office stated that this was what my insurance didn’t cover. I paid the amount. My husband went back because he couldn’t see after the surgery and that’s when we found out that the doctor’s office is in-network but the doctors are not.

Asked on July 12, 2014 under Insurance Law, Florida

Answers:

M.T.G., Member, New York Bar / FreeAdvice Contributing Attorney

Answered 6 years ago | Contributor

That is outrageous and I would file a complaint with the State Insurance Department as soon as possible and I would file a complaint with the licensing division in your state regarding the office.  It is a bait and switch situation here and you should really not be caught in the middle.  It may be advantageous for you to discuss this with an attorney and agree on a flat rate fee to write some letters for you too.  Good luck.


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