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Old 08-18-2013, 04:14 PM
cmfjr cmfjr is offline
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Yes, the statement is now standard on most questioners due to the various health insurance companies and the various plans within each company. Quite often the administrative staff can't keep up with all of the detail in each contact that they participate in. You might have a specific plan like a PPO or HMO offered by a health insurance company "A" and call your doctor/provider to verify coverage and they say yes, we accept company "A" but in fact they do accept"A" but not the PPO or HMO! You now think you have coverage, in network, when you do not.
One area that gets over look is laboratory tests. The doctor may be part of your network but the lab may not. As a member of a major insurance companies grievance committee, I see this happen very often. I recommend that one call their doctor to see what lab they use and with that information, call your insurance to verify coverage. As a rule whenever possible call for verification before receiving the medical service! Today the consumer needs to know as much as possible about their plan in order to get the services paid.