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Old 09-26-2009, 10:31 AM
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Default Can I Be Held Responsible for the Remains of My Bill

My question involves insurance law for the state of: New York



Hi, I recently went to an Optometrist for an eye exam so that I can get a new prescription for glasses. I made sure she was in my network, and called to confirm that she accepted my insurance. I went in for an appointment and she checked my insurance again while I waited. I had my eye exam and got my prescription then she suggested that I come in the next week for a test to make sure I don't have glaucoma. Did the test and thought everything was settled.



Here is the problem: I did not fully understand my insurance process which I discovered to be an HMO. So I need a referral from my doctor to see a specialist. This I should have looked up. I did not find out however until the optometrist's assistant called a month later and told me that she (the assistant) had made a mistake [img]images/styles/el-evo/smilies/wallbang.gif[/img] and that I need the referral because it will not be covered completely.



So instead of checking my insurance properly and telling me when it occurred that I would be paying out of pocket, she called me up a month later and just said oops, my boss is mad at me, sorry but you have to pay yourself now. Am I responsible for her assistant's mistake? I tried talking to them, but they are just saying sorry and to pay the amount due. Can this be sent to collections or can anything bad happen to me? I was willing to make payments, etc. because I cannot afford it due to being a full-time student but they just want their lump sum. Thank you for reading. I hope I can get some advice here.
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Old 09-26-2009, 10:31 AM
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Join Date: Jun 2009
Posts: 451,493
Default Re: Can I Be Held Responsible for the Remains of My Bill

Sorry, but unless your policy SPECIFICALLY says otherwise, the one who is responsible for knowing what your policy requires is YOU. Your doctor has several hundred patients with policies that have requirements all over the map - you have one policy only to keep track of. Checking your insurance is a courtesy doctor's offices provide - it is not their obligation or their responsibility unless the policy SPECIFICALLY in so many words says it is. By your own admission, you should have known that a referral was needed.



Yes, you can be held responsible for the balance of payment. All you can do is try to work out a payment plan with them, but the fact that the assistant, in trying to do you a favor, made a mistake does not wipe out your obligation to pay.
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