dorts

Hi all...been living in DC area for the past few months and here with work for the next while until December 2010 at the earliest. Have all the proper paperwork, visas etc and have pretty good health insurance (PPO) through work here etc although I still get paid into my UK bank by my employer at home and pay taxes etc etc back home...Im a "guest" worker here at the moment on a J1 program. Anyways, enough rambling...I recently had an accident and found out after going to the ER that I broke my jaw pretty badly...and the follow up appointments are still ongoing until my wires are removed and the doctor thinks further surgery may be required on one of the fractures also! Anyways, submitted all my medical cards etc and bills seem to be getting paid etc all correctly..so far. However, just found out that the hospital I went to was "in-network" but the doctor who performed the surgery and whos office I have been going to since for follow up is "out of network." I dodnt and was not told this at the time! Therefore, I may or may not be liable to a large slice of his costs once the claims are all made. Was worried for a while but realised I just need to wait and see, other bills for the hospital etc are all being paid ok so being an accident hopefully these costs will be covered also. However, my question is...should I continue seeing the same doctor (out of network but logical to see same doctor who performed surgery etc and I have built up a good rep with him etc and I may need further surgery by him also!) or move to an in-network doctor (although may be reluctant to take over midway through my recovery etc). Also, if I should be billed for a large slice of the doctors final bill and cant pay it...someone told me that I can just ignore it (only in extreme circumstances if it should be crazy high although my insurance should pay for most if not all of it anyways!!) as i dont have to worry about my credit record as I dont have one and I will be back home in the lovely UK by the time they try to collect any outstanding amounts. Also I dont have a bank account here in US but I do have a SSN which I will probably never need when I go home anyways so my US friends told me to just go on ahead with everything I need done and let the insurance pay for everything and if they dont pay for anything then try appealling it and if they still deny it then just pay a small amount each month and then ignore the rest when I go home. Will this effect my excellent credit record in the UK and will i have problems visiting USA again in the furture for holidays etc? Long question I know but just need advice as I am currently wired and dont want to stress of finding different doctors etc for further work!

augigi

You should pay your bills so my insurance premiums don't go up because of you.

Whether or not you switch physicians depends entirely upon whether you want to pay more for the one you have now.

Why don't you call your insurance company and find out what the deal is in terms of coverage for his treatments, then call his office and ask his receptionist if they can recommend someone else if you want to swap.

dorts

Please remember guys...I do have VERY GOOD and expensive health insurance here in the US but will feel it unfair if they should try to bill me for situations out of my control...especially seeing that they told me which hospital to go to and also I was admitted via the ER...Im new to all this, didnt expect to have to screen every doctor who saw me whilst I was admitted with a broken and painful jaw that required surgery asap! Im not trying to let someone else deal iwth anything either...this is a "just in case" situation if my greedy insuracne company refuses to pay for any outstanding bills! Also, I have and currently am under travel insurance via my company in the UK so they too may help cover costs!

Jerseygirl

How can you be covered by UK travel insurance if you're living here...or do you mean the company you work for is providing insurance?

dorts

Im working here under a J1 visa as a "guest" worker. I get paid etc fgrom ym employer in the UK into my British Bank Acccount, so coming to the US I was automatically covered under their travel insurance as I am on "business" for my employer working here as a guest. However, the employer here also required that I had proper medical insurance so I have both...so hopefully I should be more covered than most in any unforseen circumstances that hopefully wont arise...everything seems to be getting paid by my medical insurance here...I will also claim for any bills they wont pay through my travel insurance as it was an accident that happened which resulted in me going to the ER. Im just worried after reading some stories that some people, no matter how much insurance they had, ended up still owing loads of money for various different things...although my travel insurance seem to be happy to cover any outstanding bills that the insurance company here denies! Im not trying to upset anyone, Im just confused and angry that I should even be in this situation as I did everything I was told by the insurance company....not my fault the in-network hospital allowed out of network doctor operate on my jaw! Although someone said i should also appeal as it was an emergency admittion/surgery and was seriouse nough that it should be treated as in0netowrk anyways! So confusing!

ian-mstm

Did the accident take place while you were at work, or while you were on your own time?


Generally, you need permission in advance from your insurance company before they will cover out-of-network expenses. Of course, that's not always possible... such as when you're in the ER. However, the follow-up treatments should have been pre-cleared. The insurance company doesn't really care whether or not you knew you were supposed to do that.

That said, you will likely be required to pay those expenses not immediately covered by the insurance company and then submit a claim to the insurance company to reimburse you for your out-of-pocket expenses.


You should do that which makes you better, with the realization that if you stay with your out-of-network doctor you'll likely have to pay those expenses yourself and submit a claim for reimbursement.


You're free to do what you want - with the full realization that the insurance company can sue you for reimbursement - and they know where to find you! If they get nasty about it, they can get a warrant issued and the next time you set foot in the US you'll be immediately arrested.

Oh... if my insurance costs go up because you decided to act like a child instead of taking responsibility like an adult... well, I'll be pretty pissed off!


Semantics. You're working here and you're living here! You aren't a visitor and you aren't considered a "guest".


Actually... from the insurance company's point of view, it is your fault.

Oh... and one more thing - would it kill you to use the occasional paragraph to improve readibility for those from whom you seek advice?

Ian

Jerseygirl

I sympathise and I don't blame you for feeling angry. We don't really think about cost when it comes to medical treatment do we? We're not used to paying for it at the point of service.

I hope your insurers will cover the cost.

Sue

As others have suggested, the best thing would be for you to call the insurance company and find out exactly where you stand with regard to staying with your current doctor. If they won't cover it, then it's best you know now so you can arrange to change doctors to an in-network provider.

Patrick Hasler

And people wonder why Obama has the right idea ? ..... Bring on the new healthcare system asap

dorts

Well guys...sorry if I upset anyone...gonna wait until any bills may or may not arrive and then appeal it with the insurance company seeing that the in network hospital and ER doctor (all have been paid so far!) admitted me for surgery and a broken jaw is serious...andthe doctor who could operate on me quickest was the out of network doctor who I am worried about when it comes to the bills! Called today and found out the number for a few in network doctors near by so gonna (silly as it seems to me!) call the doctor tomorrow and explain I can no longer see him and then change over to an in network doctor...even though I only have a few more weeks left before being dewired...although furhter surgery may be needed so handier to be in netowrk. Will wait to see bills that arrive and update as I go but will in the meantime make sure I stay within network from now on!! Madness!!

Cape Blue

I would check what the difference in coverage costs are with you PPO between in-network and out-network, then you can get a feel for what it will cost you.

lifehouse51

A Single-Payer health care system does have its appeal.

For your Out-of-Network physician, is he running the practice himself? Is he in any position to lower the cost charged to you? Sometimes it's possible to negotiate the prices with the physician office and see if the staff's willing to give you a discount for past care/future visits. You can say, "Look, I got semi-screwed over by the Hospital because no one notified me that you're out-of-Network, and unless you charge me less, you're gonna lose my business as well as I'll have to transfer my care elsewhere"

dorts

Update is I have now changed doctors under the recommendation of my insurance company (ridicuolous how some idiot at an office can give me medical advice on doctors whilst I am still in the healing process...but enough about that!). I am now going to be going to a new "in-network" doctor on the 30th for my follow ups. Therefore, my understanding is that I will no longer need to worry about bills, just the co-pay that I pay at the desk when I go there...all other necessary costs should and will be claimed via my insurance (PPO)? Also, had to contact my current "out-of-network" doctor which I felt horrible about and had to ask for them to cancel my appointments and also to release my medical records to me for the new doctor. All this seems crazy to me but if that is the way it has to go then that is the way it will have to be unfortunately. Now it just a matter of waiting for any bills from my old doctor and file these through my travel insurance which seem happy enough so far to cover the outstanding bills..if in the end there should be any. Still in complete shock at how I have been treated by my $400 / month insurance company...shame on them!

lifehouse51

YOUR medical records are YOURS, they certainly can't refuse to release the record or refuse to let you transfer care to another physician

Cape Blue

I wouldn't be so sure about that - depends upon the contract you have with the PPO, it might be that they only pay 90% or that there is a $2K deductible each year etc - suggest you ask your HR for the details.