Not-So-Intransigent Providers: An Update
So, I reached out to co-blogger (and certified medical office manager) Kelley B, who reached out to the doc’s practice manager, who shed a great deal of light on the matter:
“We reached out to the patient to explain that [the doctor] is not in network through our practice.
There was a renal physician who passed away suddenly earlier this year in a different practice. [Our doctor] is also a nephrologist and offered to help them a little while they got their staffing situated.
[Our doctor] is in-network through them for this plan as a nephrologist not an endocrinologist.”
Ah-hah!
At about the same time, I got an email from the practice’s Accounts Manager, who added that they had long ago decided – as have *many* providers – to forego contracting with ACA-plan networks, and aren’t presently interested in reconsidering that decision. And of course she (and the aforementioned practice manager) stressed that since my client would be out-of-network she was on her own (which we already knew).
She also mentioned something that my client and I had discussed: that she’ll want to be careful about any lab work that might be ordered, in case that becomes a network issue, too.
One bright spot: the plan is HSA-compliant, and she has socked away a few shekels into it, so she can use some of those to pay for the visit (and, if necessary, lab work). Oh, and I suggested that she ask the practice if there’s a discount for paying cash (never hurts to ask).
So, mystery solved, just not a very satisfying answer.
By the way, there are some great comments on that original post, worth going back and reading.
[Special Thanks to co-blogger Kelley B, as well as the folks from the doc's practice]
Source: http://insureblog.blogspot.com/2020/08/not-so-intransigent-providers-update.html
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