Is this daylight robbery?

Chirimoya

Well-known member
Dec 9, 2002
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I've been in the situation a couple of times at private clinics when the receptionist informs me that the doctor/clinic does not work with my insurance or that my plan does not entitle me to insurance cover for that particular procedure. It is always frustrating but at least I have the choice between paying the full fee or taking my sick bod elsewhere.

What happened today seemed downright sneaky - the receptionist did not tell us we were not covered until after we saw the doctor, and said we had to pay the full amount. She had at least 15 minutes to verify whether we were eligible while we were still in the waiting room before going into the doctor's office.

We muttered the usual protests and paid up, but then thought maybe we shouldn't have.

We went to the PR department and filed a formal complaint, which will no doubt end up gracing the inner depths of their filing system.

I know that this is the DR - as Mr C reminded me - and that there is little chance we will get an apology, let alone our money back. I mainly needed to vent but also to ask whether we could have successfully withheld payment, based on the facts of the case, and whether there is anything further that could be done.

And if anyone is wondering, we didn't ask beforehand whether the doctor took our insurance because this was at a clinic in the capital that we were referred to by the clinic of the same name here on the east coast. I suppose some things - like stuff actually working according to logic - are just too much to ask for. The clinic on the east coast takes our insurance, but we learned today that its sister clinic in the capital only takes the ARS Universal "supreme" plan whereas we only have "optimum".

It reminded me that one of the few things I really miss about the UK is the good old NHS, all warts included.
 

Lambada

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Mar 4, 2004
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I mainly needed to vent but also to ask whether we could have successfully withheld payment, based on the facts of the case, and whether there is anything further that could be done.

I don't know if you could have withheld based on the facts of the case because I won't be getting health insurance here until they iron out all the bugs which probably means I'll be in my box first........but, could you not have withheld based on the fact that you didn't have that much cash with you? You'd already seen the doctor, you were quite reasonably expecting your insurance to cover it, so why would you carry cash or a credit card? You, after all, can be equally sneaky. Would they have held one of you while the other went to borrow the cash? Do they now have the right to without calling a Fiscal? Or would they have been prepared to accept the balance difference between what someone on optimum & someone on supreme pays?
 

Chirimoya

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Dec 9, 2002
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Lambada - I am sure they have mechanisms for people who refuse to pay. I've seen foreign patients at their B?varo clinic freaking out when they see the bill - an understandable reaction for people who are used to free health services - and the security guard hovering at a discreet distance to ensure they don't attack the staff or storm out without paying.

In our case we may have had some leverage but we didn't think fast enough to at least try and make a stand.

JD - if there is a lesson here it's that one should never assume that the insurance is accepted and wait for the receptionist to confirm it before going in - even when the same doctor or clinic has accepted your insurance in the past. How do we know they're not going to turn round and say "s/he doesn't work with this insurance any more"?
 

suzannel

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Jun 7, 2006
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Why not claim back????

I need to understand this...
Ok so you had to pay for your visits, but what is stopping you from submitting your receipts to your insurance company and claiming the $$$ back.
I have done this before in Cabarete's Servi-Med when the receptionnist could not get through to my insurance company in Canada for pre-approval.
 

waytogo

Moderator - North Coast Forum
Apr 3, 2009
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Did she write down your insurance number? I wouldn't be the least bit surprised if they received cash from you AND billed your insurance carrier thinking you would never check.
 

bienamor

Kansas redneck an proud of it
Apr 23, 2004
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I don't think it works that way here - I will check that out though.

Nope it don't,
Its good that Canada does, but the US does not if your plan in the US does not provide international coverage.
Also on another note be care with Labratory's here for instance Referncia Labs do not accept the same insurances from office to office.
 

chola1978

Bronze
Mar 20, 2006
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Here is my take o nthis. Private practice has itsbadside also. Now our medical profesional are extremly economical in comparison with the rest of the world...
So some one charging oyu 2500 for his services its not outragous. whats out ragoues is that its stnardad practice to denied you insurnace coverace nad later bill your insurare comapny for the serive you already paid for.. This is insurnace fraud nad unfornualiy become a comong practice in some private cleinits i n this coutnry..
My suggestions is always call your insurnace broker whne face with this issue right away.. a personal service will alwys getyu the correct info.. dont cal lthe customer serivce department just cal lyour broker.. he/she will giude you on what to do.