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Help wiht ethics (Insurance Law)

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• Thu, 29 Jan 2009 09:44:00 GMT(1)
• I have absolutely no idea why so many people believe that their doctor/hospital/other health care provider is familar with all the specific details of the insurance policies of each and every one of their patients and can keep those details straight in their minds. Nor do I understand why so many people think it is the responsibility of the health care provider to keep them informed about what their insurance covers and the details of how to apply for benefits.
  It is not. It may, on some managed care plans, be the responsibility of the provider to submit the claim. But it is never the responsibility of the provider to know the details of your health insurance plan and explain them to you. That is your responsibility. Always.
• Wed, 28 Jan 2009 16:59:00 GMT(2)
• did you ever think of contacting your health insurance company and see if what they will pay for this procedure?
• Wed, 28 Jan 2009 17:05:00 GMT(3)

• Quote:

  Originally Posted by bwqq

  What is the name of your state (only U.S. law)? California,
  Hello,
  I have a quick question. I just filed a grievance with my health care provider and my request was refused. My wife and I just had a baby boy and we were undecided as to whether or not we wanted to have him circumcised. Upon asking our pediatrician for information about circumcision he was clearly against the procedure. He neglected to inform us that there was a 3 day time frame to that the procedure needed to be performed in order to reduce health risk and only pay our co-pay. At our next appointment when we asked for a referral to a pediatrician that performs the procedure he told us that because we were out of our 3 day window we would have to pay for the procedure out of pocket and there would be dramatic increase of health risks to our son. We filed a grievance with the hospital and requested that if we elect to have the procedure done it be at the cost of our normal co-pay. We were denied. We both feel that this the pediatrician in question intentionally withheld the information from us to put financial influence on our decision. What can we do?

  I don't think it's the doctor's job to keep you informed as to your health insurance company's policies.
  While you may ~feel~ that he "intentionally withheld" info from you, you'd have to prove it. That would be quite difficult.
• Wed, 28 Jan 2009 23:31:00 GMT(4)
• You could have done your own research, both on your benefits and on the procedure, on your own time and within the window. You could have called and asked for the referral between appointments. I'm not violently against circumcision, but at this point since you are outside the window and the risks do go up now, why not just leave it be and let him decide if he WANTS to be circumcised when he is older? If he does develop an infection or other problem related to the foreskin, your insurance will cover the circumcision at that time because it is due to a medical diagnosis. Most insurance companies will only cover a purely elective circ within a short time after birth. Most OTHER purely elective/cosmetic procedures are not covered at all under any circumstances!
  However if you are displeased with your pediatrician, by all means find another one.
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