Healthcare Loophole

Wednesday, September 20, 2017

I’m just curious if others out there are experiencing this issue with healthcare. More and more I’m running into situations where facilities are in my insurance network but when I receive the bill I’m informed that the provider was not.  It has happened to me twice in the last few months.

The first case involved my son receiving treatment for a laceration at the Erlanger Medical Center ER. It seems that Erlanger is in the Gilsbar Insurance network, but the ER physician that treated him was not.

The second case involved my wife having a wellness mammogram at Chattanooga Imaging. Again the facility was in network but the physician that read the mammogram was not. In the Chattanooga Imaging case they filed the entire visit under the physician’s ID number so Gilsbar does not want to pay for any of it…..the mammogram or the reading.

I guess now you have to ask every doctor that walks in your room for proof that he/she is in your insurance network. Oh, and if you have a test read by a doctor that you will never meet….well I guess it just the luck of the draw. 

These situations work out well for the insurance companies because they can refuse to pay. It also works out well for the provider because they can bill for the full amount since they are not restricted by an insurance contract. However, the patient (who has no control over the situation) is the one who gets trampled on.

To be honest, it really looks like the insurance companies and the healthcare providers have found a loophole in the insurance laws that they can both benefit from.

Bill Peers 

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