Mail Call : Can medical providers force you to pay up front?

We’ve all been there – you go to the doctor, dentist or optometrist and are asked to pay for certain products or services up front.

You’ve probably thought, “Isn’t that what my insurance coverage is for?”

In this week’s Mail Call, Compass editor-in-chief Kevin Morales takes a look at whether medical practitioners are legally allowed to make you pay up front, leaving you to request reimbursements from your insurance company.

The answer? No, they are not.

According to the health insurance regulations, if someone shows an insurance card to a health care facility that verifies a medical benefit is covered, that amount must be assigned to the practitioner.

That means the patient would only be required to pay the remaining amount that is not covered by their policy.

In other words, the insured cannot be asked to pay the whole bill up front.

That said, you might run into difficulty on weekends or after hours when insurance companies are closed. Approved insurers must offer contacts, or have an online portal, for medical practitioners to confirm coverage during those times. But that doesn’t always happen.

If you are asked to pay the full amount for after-hours care, you should submit a claim to the insurer to reimburse the total that is covered under your policy.

But that’s not the end of the story if you are asked to pay a bill up front. In addition to paying and submitting a claim for the insured amount, the patient should also file a formal complaint with the health insurance commission to have the matter investigated.

It’s worth noting if you’ve exhausted the specific benefit being checked on, then you’d have to pay that amount out of pocket.

We know you’ve got questions and we want to find the answers. Got a burning question for our Mail Call segment? Email us at [email protected]

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