If you have United Healthcare or Oxford United Healthcare, please note that I am not an in-network provider for those plans, and due to the company’s reputation with other providers, I do not plan to be. In addition to other problems I have heard, they issue confusing Explanation of Benefits statements (EOBs.) If you are on a policy that does not include out of network benefits (OON) and you submit a claim for a provider who is out of network, your EOB may indicate that you don’t have any liability for the claim. This is very strange, and I haven’t seen another insurance company do this. Please understand though that an EOB is not a bill (that is also printed right on the EOB you receive in the mail) and it does not reflect your liability with the provider. It is a statement of your insurer’s benefits provided (or not provided) for services rendered.
All clients at my practice have to sign a billing policy that allows me to bill the insurance company on their behalf in order to submit claims. That policy also states that if benefits are not available for the service, the client is liable for any charges not reimbursed.
I am not putting this out there to be greedy. I work with all my clients as best as I can to make payment arrangements that are feasible. I am a sole proprietor and I do need to keep the lights on so I can keep seeing you though, so please understand that it is important that everyone meets their obligations here.
Whenever you sign-up for benefits during open enrollment or when you change jobs, if you are in doubt, or even if you aren’t, always verify with your HR department that the policy you are buying into meets your needs. I’ve dealt with payroll deductions for insurance before. I know it stinks to get a big chunk out of your check for a more expensive policy, but the cheapest option is basically worthless if it doesn’t meet your needs, aka if none of your providers are covered by it. Any current client of mine who needs help navigating the process is welcome to contact me as well. I will review information with you, and I can do whatever possible to help advocate for you with your benefits specialist. I can’t go back and undo a commitment you already made though.