New Pain Clinic dropped me like a hot potato after 2 months of treatment because of insurance

About 2 years ago I found a great pain doc and was very happy with the treatment I was receiving from him. Then he joined a pain clinic in December and I followed him. No problems so far right? So I make an initial appointment and a few others in the last 2 months. No problems again and was happy with the care I got. Then Wednesday came. I get a call from the Pain Clinic out of the blue and they told me that all of my treatments were in a pending status or being denied by my insurance company and all future appointments were cancelled. Now mind you, I have been going there for 2 months of treatment equaling thousands of dollars per procedure. I was in shock! I didn't know what to do! Here I am in the middle of treatments from this clinic and they drop me like a hot potato! No advice on what to do or where to go that will help me with minimal amounts of medication since I had just started the Medication Protocol last week.

Luckily I saw my GP on Thursday and he was able to help me a little and gave me some advice. They should have known they didn't take my insurance from day one, before they treated me. They should have asked over the phone what it was and then the front desk should have known what insurances they take!! My GP found that lack of due diligence utterly deplorable! He said to NOT pay their bill when it comes in. Paying it would mean I accept their terms for the treatments I received! I had a sleep study done, an initial consultation, 2 medication consultations, a trigger point injection and a facet injection. My GP gave me refills of my meds that needed to be done ASAP since my Tramadol was only for 15 days and I was running low on Ambien. I also take Norflex, but I have a refill left on that so I am okay.

It is so irresponsible how doctors treat us fibro patents! We are not fakers, drug seekers or doctor shoppers! We are in pain! Now I have to find a new pain management doctor or clinic before my next visit with my GP. This was something I should not have had to do. According to my doc, it is not my responsibility to know if they are in my system of doctors. I should have been told right away before any visits were made! The moral of my story, before you see a new doc, ask if they take your insurance if they don't ask first! Don't ever get into the fix I am in.

Hi Wendy - what you are going through is what I have been talking about. For 30 years, I have been bounced around all over the place to find someone to help me! I have a question!! WHY are we Fibros having so much trouble getting the help we need??? Is it because the Doctors don't really believe us? Do they think we are trying to get pain meds for the fun of it? Maybe they think we are hypochondriacs?? One time, years ago, I had an appointment with a Arthritis doctor. I had been under his care for about a year. Well, I went to my appointment, and he said to me, ''What's wrong with you NOW??'' OMG!!!!! I was ready to give him a black eye! Jeez! Well, I think you all know what I did after he said that. I told him off as ladylike as I could. I didn't want to stoop to HIS level and cuss his head off!! I don't think I will be able to sleep tonight and it won't because I am in pain, It will be because I am SO p----- Off! Oh great!! Not only will I go to bed angry, but I have my hip pain to contend with now. I just can't win!! Hugs, Laurie

HI Wendy - I had the same problem a couple of years ago. I have learned to ALWAYS ask if they take my insurance first, because I had a few surprises in NOT asking what insurance they take. Laurie

Hi Wendy,

Renie is the gal to talk to about this, she worked and managed the office of a Rheumatologist for about 11 years, though I think your PCP hit the nail on the head. Their responsibility! So unusual that they did not check into this before you got in the door to see him the first time. Poorly managed business in my opinion.

Hope you can still get the care you need!

Wendy, have you called your insurance company to find out why nothing has been paid? It was lousy of them to just drop you like they did, but it is the patient's responsibility to know what their insurance covers. Most offices make sure that they also know, prior to seeing someone, because they want the doctor to get paid. But if they have a lousy receptionist who just didn't do a good job of verifying coverage, then this can happen.

In several of the offices I visit, there are signs in the lobby that state "It is your responsibility to know what your insurance covers, not ours" and I've also had to sign a form acknowledging that if my insurance doesn't pay for something, it's my responsibility to pay it.

I'd call your insurance company and see what the problem is.

Good luck,

Sharon

Thanks Laurie. I have definitely learned my lesson on this one. What I assumed was that since my pain doc was joining this clinic, he would still be in the system. At the same time, the mistake should have been caught sooner.

Thanks Sharon. Of course, you are right, I should have known better and should have asked. They take Medicare, which I am on along with my part D and they told me they used my part D as my primary insurance and won't charge Medicare because they are considered my secondary. Whatever that means exactly I am not sure.

The insurance I use is pretty much taken in this area with no problems at all, this was the first time that no one mentioned anything about it. I mean geez after 2 months? When I had my teeth cleaned one day and handed them my insurance card, within minutes they told me they didn't take it. So I have had to pay slowly a cleaning appointment. Luckily, it was relatively small bill. This one is going to be huge!

Funny part is, every month I get a statement of claims sent to me by my insurance and not any time was it indicated that they were denying my claims. After filling out the needed paperwork, someone should have caught this before the appointments got out of hand. What a mess.

I agree with you, Wendy. One of the first things they ask me here in Wisconsin is what insurance I have. When trying to find a doctor (been through a few) I have been told they don’t take it. I am also quick to make sure they are in network, as out of network doctors cost me more out of pocket. the charges I incurred for 10 minutes of seeing an EENT doc (PCP thought he should read my MRI results be ause it mentioned mastoid - gee whiz) and him telling me I never really needed to be seen cost me $183 - insurance paid the rest to equal $384! Unbelievable!

Hopefully, your old doc just didn’t have his insurance all set up for the transfer and they’ll get it straightened out. I’d check with your insurance company and give them the scoop of his move and being treated by him continuously. Best of luck!

Hi Wendy - I too am on Medicare. Do call Medicare for help. You cannot be charged for anything if the provider accepted Medicare at the beginning. And Medicare has to be primary. I am wondering if the office folk are too new to know what they are doing.

Wendy, I agree with PracticalMystic - maybe the office is billing incorrectly. Definitely call your insurance company on Monday. They'll tell you why the claims are being denied.

Good luck.

Sharon

HI Wendy - you had every right to assume that your pain doctor would continue to take your insurance. Things are so complicated now, what with all the paper work we have to go through and questions we need to answer. Doctors are terrified of being sued, so they try to squeeze every ounce of info out of you. Then what do they do???? Say. ''I am so sorry, we don't take your insurance!!'' OR they DO take your insurance and give you crappy treatment! Honestly - we can't win - can we!! Love, Laurie

I already know the answers to some of your questions. My doc who closed his own practice and joined this pain clinic took my insurance without a problem because he was in network. Every doctor, as well as the practice itself are out of network as well, but are covered by Medicare. I cannot even get a referral from my GP or my old pain doc (who is now part of the clinic) to override the issue. I looked into that myself. The Billing department, is refusing to bill Medicare at all for my treatments because my Medicare is second. I thought that if my Part D didn't take care of it, Medicare would take up the slack. I was wrong.

I swear what do they expect us to do, be experts on insurance, medicines, procedures and other miscellaneous stuff beyond trying to take care of ourselves? As you all know, being chronically ill is a full time job all its own, then pick up the pieces when they drop the ball...another full time job! This is what they are being paid for, not me. They should not have treated me the moment they saw my insurance card.

Ooh Wendy, I'm sorry you've ended up in this fix! i always ask docs offices if they accept my insurance right off the bat. And sometimes if you're having a procedure done, the anesthesia docs don't take the same insurance as your doc, so you can also end up in a pickle in that situation too.

The real consequences of your not paying this bill is that you'll end up with a substantial ding in your credit rating, which could affect you for buying or renting a home or car, and probably other services as well. Also, even worse, you'll get those areshole credit collectors on the phone who won't care how ill you are, how early or late they call or how brutal they'll be to you on the phone in order to collect the debt. And they'll call day after day after day. Your sanity will implode from the sheer number of calls.

Maybe you could go to Legal Aid and ask for some assistance with this situation. I'm not sure if you have any legal remedy available to you because, like it or not, it is our responsibility to find out if new docs/clinics/procedures are covered by our insurance. I'm just so sorry that you got caught in this horrible situation and hope you can find someone "right quick" who can treat you for the pain.

i just saw this posting, but already posted something prior to reading it.

If they accept Medicare, then why isn't it covered, at least in part? Why don't they bill Medicare instead of Part D? If you haven't already asked them if they've done this, I would suggest calling and asking. I would think that Medicare might pay for some parts of the treatment but maybe not others. Or else, if this is a very controversial treatment, then it's possible that most insurance companies wouldn't pay for it.

Again, I feel for you. When I left my full time job and thought they were still covering my medical expenses, due to a disability policy I'd paid for (useless, as it turns out,) and due to something the receptionist told me about their covering it, I ended up being told after about 3 months that *I* was responsible for paying for the health insurance and since I hadn't, it had been cancelled. And since it had been cancelled, like you, I would be responsible for thousands of dollars worth of procedures. Like you, I was extremely upset but I was also scared spitless about how to pay for thousands in medical bills when I couldn't even work. I waited breathlessly for those bills to come. They never came. It's been about 2 years and still no bills. I just pray they never do come! I also hope that yours don't either, by some odd fluke like the hacking group Anonymous hacking into the medical accounts of your pain clinic and removing your bill. Good luck to you, dear.


Hi Wendy,

What is your primary insurance, Medicare? Part D is for prescription coverage only, so it wouldn't apply for a doctor's visit. Even if they provide medications during your visit, they would fall under the doctor's services, not prescription. Do you have another insurance policy that covers medical services? It sounds like the doctor's office isn't billing it correctly, so don't pay them anything yet !

I'll try and help the best I can if you can give me a little more information.

Renie

Unfortunately their going to tell you it’s your responsibility to check with your own insurance co to see who is in or out of network. If your dr that joined the group was still in network when he joined maybe you’ll get lucky and they’ll at least cover the first month. I’ve worked in drs office so many years, in our practice we didn’t have time nor the manpower to call each patients insurance company to verify, it was ultimately the patients responsibility to make sure. Sorry to tell you that…

Wendy, this just happened to me recently. My neurologist dropped me because of Medicaid. I, then, went to my first and last appointment with a pain doc who did nothing for me. I got a call yesterday from the pain doc saying they have two medicaid numbers for me. And, my ex hubs insurance also. We divorced six years or so ago. Anyway, the doc treated me like he didn't care and wanted me to just go. I will not be paying for a darn thing either! It makes me angry that docs treat people as if they are non-existent. If there were someone for me to contact about the lack of knowledge on fibro, I would sooo write them, call them, or visit them. Hope you have success in pain management in the future!

HUGS!!!

I'm so sorry for your frustration Wendy. They wouldn't have known from day one, because Obamacare has changed everything, and I hear more and more people here every week being dumped because doctors will no longer accept Obama's version of medicare or a few other HMO insurances.. Some doctors will take you back if you offer to pay cash for your treatments, but not everyone can do that. Obamacare was supposed to make it so everyone had insurance. So now no one can be denied insurance, but doctors can reject that insurance. The news says that in the next month, 7 million people will lose their work-supplied health insurance because the employers can no longer afford to pay it. The rates have raised so high, to cover all people who are high risk who now can't be rejected from getting insurance.

Saying you are not alone doesn't help much, but I hope you can find a Dr. who will take your insurance.

Best wishes, Sheila

We're probably in the high risk group, alas. But it is scary to think of people losing their health insurance from work. And Obamacare demands that you have insurance of some type, so you'll have to pay it out of pocket. It's a good idea on paper but not too practical in reality.

Sheila - are you on Medicare? I am and have not found what you say to be true. If one chooses to be on an HMO version of Medicare, which I think must be what Wendy has, there are more limitations. I checked with our local Office for the Aging when making my annual decision about Medicare part “D” choices. Way before Obama care I was advised that the HMO version is not advised for people with chronic illness in need of frequent Dr. visits. It is very limiting which is why the HMO companies like it. They make money off of Medicare. It is only the HMO versions that now have more limitations on what they make. They were getting rich off of Medicare by disallowing care to patients.