Doctor's office said they take my insurance plan but insurance company said they're not IN-network (hospital, Texas)

[Surfertx]

I have a Texas BCBS HMO plan and called their customer service to get a full list of providers for my zip code. And of course the nearest one is like 20 miles away However, I did find a closer office after searching the BCBS web site under "Cost" finder.

I called that office, talked to the billing person and she confirmed they DO take BCBS HMO's. So I'm not sure who is wrong here and should I use this provider?

[Flamingo13]

You need to go to someone in-network if you want the best rates - someone not in-network can bill your insurance company for you but you'll pay the out-of-network rates.

[Surfertx]

Originally Posted by Flamingo13

You need to go to someone in-network if you want the best rates - someone not in-network can bill your insurance company for you but you'll pay the out-of-network rates.

ok that makes sense, thank you.

[Angie682]

Any doctor or hospital will "take" your insurance. Whether or not they are in network is a different story. Use the provider on the list your insurance company has provided OR call your insurance company to verify that the other provider really is in network.

If the insurance clerk at the doctor's office is wrong and they are out of network for your specific plan, they are going to balance bill YOU for the entire billed charge. Don't ever rely on the provider telling you they are in network. Always take the extra step to verify with the insurance company

[BOBNCHI]

Texas BCBS HMO, they are paying the bill, I would base my decision on what providers they say are in network.

There have been so many changes the office staff are not always up to date.