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I recently had an unsatisfactory experience with a health care provider.. It was paid 100% via insurance and i feel my coverage has been wasted.
Generally, will opening a complaint againsy provider to my insurance be a waste of time? Is there any chance the insurance company would say i wouldnt be on the hook for the services rendered?
I fear complaing about bed side manner and quality of service would be considered trivial in my case.
I recently had an unsatisfactory experience with a health care provider.. It was paid 100% via insurance and i feel my coverage has been wasted.
Generally, will opening a complaint againsy provider to my insurance be a waste of time? Is there any chance the insurance company would say i wouldnt be on the hook for the services rendered?
I fear complaing about bed side manner and quality of service would be considered trivial in my case.
Wasted? Not sure I understand. Are you saying you want something refunded? Has the claim been paid or not? Did the provider do what was contracted for and were the procedures clinically appropriate/approved for your situation? If so, why wouldn't your insurance pay for it? There's "quality of service" as in medically appropriate and there's "quality of service" as in bedside manner. Which is it? If you didn't like the provider's manner it might do more good to tell the practice instead of the insurance company. I'm not suggesting you should ignore insensitive treatment, just that your insurance provider probably doesn't withhold payment because you didn't like someone's manner. Ask your insurance carrier how to submit a provider review. If, by your own admission you aren't sure your complaint would carry much weight, nothing may come of it.
From what I can understand from the post - insurance paid for everything @ 100%! If there is an issue w/quality of care, etc. - that is an issue to take up w/the hospital/provider.
Appeals Supervisor here -- if you have a grievance about how the doctor treated you -- for instance you sat in the waiting room too long or you believe the doctor did not order the right tests, you were unhappy with bedside manner -- we do not intervene in those kinds of situations.
If the provider rendered a service to you that is covered they are entitled to be paid for those services.
If the provider is an in-network provider we can forward the grievance directly to the PPO. If the provider has excessive complaints some PPO networks may not renew the provider's contract.
If the provider billed the claim incorrectly and it was denied you can file a formal written appeal within 180 days from date of original denial.
I had to seek a second opinion .... will i have issue with the insurer when they have similar claims from two seperate providers at the same time?
Typically no. If they are billed by different provider's with different tax identification numbers you should be fine.
Unless your plan specifically excludes second opinions (rare).
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