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Can a health care insurance company reject your claim if your doctor specified the treatment?
Wiki User
∙ 16y ago
Absolutely. Health plans only pay for what the policy states. Even if your doctor says something is medically necessary, if the policy does not cover it then they do not pay. The easiest example is drugs. if your plan only pays for generic drugs and your doctor says you must take a non-generic then the insurance will pay zero.
Wiki User
∙ 16y ago
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Does your own doctor's recommendation supersede another doctors recommendation i.e an insurance co.'s doctor?
That depends on what you mean. In terms of whether you can legally receive a treatment that is restricted to a doctor's prescription it is your own doctor that counts. If you are trying to get an insurance company to pay for it then it is the insurance company's doctor that counts. The denial of coverage letter always points out that the insurance company is not issuing medical advice as to whether or not you should have the treatment. They are merely determining whether they will pay for it. They may deny it because they think it is not proven effective (i.e. experimental), because there are less expensive alternatives (like generic drugs) or for other reasons such as pre-existing conditions.
Does your primary doctor perform the physical for life insurance?
It can be your primary doctor or a doctor that the life insurance company chooses.
How do you find a Doctor Who accepts assignment?
Typically, you find a doctor who accepts assignment from your insurance company by contacting your insurance company for a list of participating providers.
Are you obligated to pay a doctor for a treatment the insurance told him would not be covered?
Yes.
Can a doctor's office keep a credit card number of file to charge me in the event that my insurance company doesn't pay him within 30 days and then reimburse me when he finally receives the payment?
Yes. Typically, it is the patient's responsibility to pay. The doctor's office will file the paperwork for you (usually) with the insurance company. But, if the insurance company doesn't pay them, then they will have to get the money from you. If he does get the money from you, then you can go to the insurance company and ask for reimbursement, or wait for the doctor to reimburse, when he finally gets paid from the insurance company.
Can a doctor charge you more for the remainder if the insurance pays what it is worth?
The doctor bills insurance for your office visit. Insurance will pay the doctor their contracted rate and the rest is written off. if you are billed for charges after the insurance paid, call your insurance company.
Who files the claim?
When one visits a doctor's office, their insurance information is usually collected. After the visit, the doctor's office will bill the insurance company directly for their services. If any of the expenses billed are not covered fully by the insurance company, the individual will likely receive a bill from the doctor's office.
What is Amount payable by insurance company for insurance?
This is the amount paid by the insurance company to the doctor. It is the negotiated rate less the amount that you paid in the form of a copay, a coinsurance, or a deductible.
What recourse do I have when a doctor sends me a bill for a procedure because the insurance company has denied coverage for what I think is a bogus rationale?
Take the Insurance company to court. The Doctor has to be paid by some one. and in the end it is you that is responsible for this.
Treatment Center for Depression?
form_title=Find a Treatment Center for Depression form_header=Look for treatment centers in your area. Do you have medical insurance?= () Yes () No Have you sought treatment before?= () Yes () No Have you been to a doctor or therapist?= () Yes () No
Your doctor is holding back on your surgery because of your insurance can the cancer spread?
Yes. You need to take steps to get into treatment sooner if the only holdup is an insurance issue.
Does a doctor have the right to charge you more than the copay on your insurance?
That depends on 2 factors..1. is your doctor in your insurance company's network if no then yes he/she can charge you up to the billed charges subtracting what if anything your insurance company paid. 2. Is things like labs, x-rays and procedures covered under your copay or do they apply to your deductibles and coinsurance? When in doubt contact your insurance company
