Re: and Shane (esp.) & all!

[Guest guest]

I am asking because I wonder if I am overreacting to this kind of

thing. You two especially seem to deal with ethics.

Tami

> If a provider refuses to treat a patient because his first bill

isn't paid, even when insurance has approved payment, given an amount

to be paid, and just hasn't received the check yet, is that ethical?

>

> Just to be fair, let's say the insurance did approve late.

>

> What do you all think about that?

>

> Tam

[Guest guest]

Kimry did have a point about the patient or parent having to sign the

agreement to pay if the insurance comp. didn't pay. All the doctors offices

that I've been too have me sign this kind of form...I was under the

impression that if you DIDN'T sign the agreement you would have to pay up

front or they wouldn't provide care.(but at least you have the option of

choosing another physician then )

I'm curious though...what are over reacting to? Is it what and

Shane have been discussing or something else ?

Just an FYI ...I feel very fortunate that our son was able to have the

helmet therapy.Also that we didn't have to jump through a single hoop to

have the insurance company pay for it.I do wish that we could have had ALL

the different therapies presented to us before we made our decision.I would

LOVE to see the day that parents of children with plagio. can just ask for a

referral to a neurosurgeon/craniofacial surgeon/whatever and have ALL the

options laid before them.Then for the all the insurance companies to cover

this 100%.

I just want ALL our babies to grow up healthy and happy . ) As I'm

sure ALL of us do !

~Jill

----- Original Message -----

From: Tami Warner <twarner@...>

<Plagiocephalyegroups>

Sent: Friday, May 19, 2000 11:52 AM

Subject: Re: and Shane (esp.) & all!

> I am asking because I wonder if I am overreacting to this kind of

> thing. You two especially seem to deal with ethics.

> Tami

>

>

> > If a provider refuses to treat a patient because his first bill

> isn't paid, even when insurance has approved payment, given an amount

> to be paid, and just hasn't received the check yet, is that ethical?

> >

> > Just to be fair, let's say the insurance did approve late.

> >

> > What do you all think about that?

> >

> > Tam

>

>

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[Guest guest]

> > > If a provider refuses to treat a patient because his first bill

> > isn't paid, even when insurance has approved payment, given an

amount

> > to be paid, and just hasn't received the check yet, is that

ethical?

> > >

Can't say I've had any experience with this type of situation.

However, as a consumer, I can tell you what my wife would do.

1) Contact the insurance company to see why payment had not been sent.

2) Assuming your insurance company still plans to pay, I would ask

them to contact the provider to let the provider know.

3) I would contact the provider to tell them you have contacted the

insurance company.

4) If you are still not satisfied, I would contact the state

insurance officer (whatever the title-- or the state attorney

general's office).

Good luck. I hope that a few phone calls would clear this up.

[Guest guest]

My insurance likes to pay everyone late. They always come up with

some excuse to why payment has been put off. Usually not enough info

sent from the provider. When you go to the doctors bring all your

current and past bills. Stapple doctor bills to explaination of

benifit papers from the insurance co. If you have recieved a bill

from the provider because payment hasn't been made and you do not

have an exp. of ben. from the insurance ask the provider when they

sent out the paperwork to ins. for payment. Ask if they got a

response, who they talked to, etc. They usually document all calls to

ins. when doing billing.

Another good one is to ask the provider if they provide the service

of billing the insurance company. If they say yes, then ask why they

didn't get a confirmation of coverage. If your ins. agreed to cover

then they usually tell the provider what portion...if any is the

patients responsability.

Always keep good records as to whom you talked with and what they

said. Good luck. Sorry so long. But I have a lot of problems with

this one! I think I know all of my insurance claims people by name!

>

> > > > If a provider refuses to treat a patient because his first

bill

> > > isn't paid, even when insurance has approved payment, given an

> amount

> > > to be paid, and just hasn't received the check yet, is that

> ethical?

> > > >

>

> Can't say I've had any experience with this type of situation.

> However, as a consumer, I can tell you what my wife would do.

>

> 1) Contact the insurance company to see why payment had not been

sent.

> 2) Assuming your insurance company still plans to pay, I would ask

> them to contact the provider to let the provider know.

> 3) I would contact the provider to tell them you have contacted the

> insurance company.

> 4) If you are still not satisfied, I would contact the state

> insurance officer (whatever the title-- or the state attorney

> general's office).

>

> Good luck. I hope that a few phone calls would clear this up.

[Guest guest]

,

Good advice!

> My insurance likes to pay everyone late. They always come up with

> some excuse to why payment has been put off. Usually not enough

info

> sent from the provider. When you go to the doctors bring all your

> current and past bills. Stapple doctor bills to explaination of

> benifit papers from the insurance co. If you have recieved a bill

> from the provider because payment hasn't been made and you do not

> have an exp. of ben. from the insurance ask the provider when they

> sent out the paperwork to ins. for payment. Ask if they got a

> response, who they talked to, etc. They usually document all calls

to

> ins. when doing billing.

> Another good one is to ask the provider if they provide the service

> of billing the insurance company. If they say yes, then ask why

they

> didn't get a confirmation of coverage. If your ins. agreed to cover

> then they usually tell the provider what portion...if any is the

> patients responsability.

> Always keep good records as to whom you talked with and what they

> said. Good luck. Sorry so long. But I have a lot of problems with

> this one! I think I know all of my insurance claims people by name!

>

[Guest guest]

Thanks everyone!

The situation was already resolved, and I did what and

suggested. I was just wondering if this was something everyone runs

into, like a standard practice. We have been through so much with

all of the plagio and $$$ issues, I thought maybe I was overly

sensitive to this kind of practice. I guess I must be.

I thought I would get more insight if Shane (being a medical

professional, M.D.) and the banter at the time with , would

offer some insight whether this was common for all medical

providers.

Tami

[Guest guest]

I'd have to say that's not only unethical, but bordering on illegal---if the

payment has been guaranteed, what's their problem ?

Doesn't sound like this " health care provider " is worth having if that's

their way of doing business.

Shane J s

----- Original Message -----

From: Tami Warner <twarner@...>

<Plagiocephalyegroups>

Sent: Friday, May 19, 2000 11:52 AM

Subject: Re: and Shane (esp.) & all!

> I am asking because I wonder if I am overreacting to this kind of

> thing. You two especially seem to deal with ethics.

> Tami

>

>

> > If a provider refuses to treat a patient because his first bill

> isn't paid, even when insurance has approved payment, given an amount

> to be paid, and just hasn't received the check yet, is that ethical?

> >

> > Just to be fair, let's say the insurance did approve late.

> >

> > What do you all think about that?

> >

> > Tam

>

>

> ------------------------------------------------------------------------

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>

[Guest guest]

Tami :

To clarify , I am not an MD, I'm an RN with a specialty in Pediatric and

Adult Plastic & Reconstructive Surgery, as well as Neonatal ICU training.

Shane J s

----- Original Message -----

From: Tami Warner <twarner@...>

<Plagiocephalyegroups>

Sent: Saturday, May 20, 2000 8:23 AM

Subject: Re: Re: and Shane (esp.) & all!

> Thanks everyone!

>

> The situation was already resolved, and I did what and

> suggested. I was just wondering if this was something everyone runs

> into, like a standard practice. We have been through so much with

> all of the plagio and $$$ issues, I thought maybe I was overly

> sensitive to this kind of practice. I guess I must be.

>

> I thought I would get more insight if Shane (being a medical

> professional, M.D.) and the banter at the time with , would

> offer some insight whether this was common for all medical

> providers.

>

> Tami

>

>

>

>

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