Dear Money Helps: In April 2005, I went to the Web site of my insurer, United Healthcare, to look for an in-network physical therapist. I found one and saw him several times, each visit paying the $15 in-network co-pay. Then, a full year later, I received a bill for $1,732 from UHC; it says my doctor is out of network! I've called and written letters to no avail - and now my account is going to collections. Help! - From Mary Jo Albrecht of Dania Beach, Fla.
Ah, the familiar game of you said, they said. In this case, however, there appears to be a ringer, and it's not you. United Healthcare reports that your doctor was a member of its network prior to April 2005 and then again after April 2006 - but not, unfortunately, between those dates, which is when you saw him.
Perhaps you found him in a Web search while he was still a UHC member provider, wrote his information down and then made an appointment with him after he'd fallen out of the loop. In theory the doctor's office should have informed you about the change in status, but the receptionists aren't always up to date.
Game over? Maybe not. There's also the chance that the company just failed to update its site. Unfortunately, there's no way to tell what information was accessible to you - or when. "We cannot say with certainty that the doctor's name wasn't still on the Web site after he dropped out of network," says UHC spokesman Roger Rollman. Because of this, United agreed to cover all your expenses less the $15 co-pay for each visit, a total of $1,732.
A single doctor's contract with an insurer may come up for renegotiation as often as once a year. Given the volume of changes that this precipitates, the carriers' Webmasters can't always keep up. So while searching online is a good first step, you should also call the insurer's customer service number and have a doctor's status verified. Have the rep put a note in your file that you called, in case disputes arise later.
Another option: Call the doctor's office directly and ask to speak to the folks who handle insurance issues. Have them fax you written confirmation - and they'll be sure to get it right.