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Not-So-Intransigent Providers: An Update

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The other day we posted about what appeared to be a rather unfortunate problem for one of my clients:

Dr. [redacted - for now] is in our system under 2 separate Tax ID’s. Only one is actually in our network, and the location the patient’s supposed to go to isn’t.

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.”


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]

Original content copyright © InsureBlog


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