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Dimitry K., Esq.
Dimitry K., Esq., Attorney
Category: Legal
Satisfied Customers: 37621
Experience:  Multiple jurisdictions, specialize in business/contract disputes, estate creation and administration.
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I set up an appointment with an ent doctor and the office personnel

Resolved Question:

I set up an appointment with an ent doctor and the office personnel told me they accpeted my insurance. 3 months later and a big bill, it turns out they do not accept my insurance. I would of never gone if they would never would accepted my insurance. My friend also called and pretend to set up an appointment using my same insurance coverage, and they told him the same thing that the insurance is in network. So they lied to me and him.

Secondly, i decided to get the sinus surgery done because the doctor's assistance told me my insurance would cover the whole surgery 100%.
After my surgery and 2 months later, i'm getting a bill from the doctor saying I owe money from the surgery. Following the surgery, every single week i went back for a post op visit and he would prescribe anitbiotics. The doctor prescribed this to me for almost 3 months and i'm sick of getting antibiotics.
I went to a new doctor yesterday and she said that my nasal canals are starting to close up already and theres a lot of scar tissue. The surgery cost me $33k+ which i only paid $25 cause of my insurance. But the doctor now has sent me a bill for surgery after they told me everything was cover and even checked and came back to verified everything in front of my face. I'm not sure what to so because I feel that I have been lied too, paid a big amount for surgery I had on June 19th 2012 and i'm still not breathing right and on top of that a big bill.

I feel
Submitted: 1 year ago.
Category: Legal
Expert:  Dimitry K., Esq. replied 1 year ago.

Thank you for your question.

My apologies to you and your situation. As much as it pains me to give you this answer, in terms of coverage it is not the responsibility of the facility to inform you if something is covered, it is your responsibility to review your own coverage limitations or even contact the insurance provider so as to obtain limitations or pre-approval prior to the procedure being performed. If your insurance is not accepted, or not fully accepted, the remainder is still your responsibility since you were the benefited party (the one who signed off on the procedure, promising to cover the debt, and also the one who actually had the benefit directly). At you can contact your insurance and have them re-evaluate and possibly review to see if they denied the claim by mistake (the facility might not be at fault, as insurance providers are not often in a hurry to cover bills), or work out some sort of a payment plan with a facility. If worst comes to worst, you are potentially able to seek bankruptcy as a means of avoiding payments--medical grounds happens to be one of the top reasons most pursue personal bankruptcy at this time.

Good luck.

Dimitry K., Esq., Attorney
Category: Legal
Satisfied Customers: 37621
Experience: Multiple jurisdictions, specialize in business/contract disputes, estate creation and administration.
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