In network doctors not showing up

[jack3454]

I’m having issues with doctors showing up as not in network for many plans with different companies. Not showing on quoting tool, not showing on carriers own look up, etc. Sometimes I’ll call the doctor and they’ll say Yeah this doctor is accepting this plan or they’ll say “we can’t tell you, you have to call the insurance or look on their website”. Ive been give tax IDs by doctors offices and told to call insurance companies, and then the insurance companies say they have no way to look up by tax IDs.

Most recent was a person who has been going to the same doctor for years. Dr retired, and now no other doctor is showing up as in network for the same doctors office. Yet I call the doctors office and they say “yeah they all accept this insurance”. Who am I supposed to trust here? The doctors office or the insurance search? Why wouldn’t the insurance own provider search tool have correct information??

Im getting massive headache just dealing with if doctors are in network alone because every time one isnt showing up, I dont know if thats true or not. Is there a tried and true method to solve these issues? Im trying to reduce my phone hopping.

 

[somarco]

Once upon a time . . . in the early days of managed care and before Algore invented the internet, carriers published network directories printed on dead trees.

The directories were outdated before the ink was dry.

Fortunately for my clients, none of them have to worry about who is in and who is out of network. But for the rest of the folks, you can rest assured that you and your clients will go crazy trying to get a correct answer.

The par/non-par game changes so rapidly that the provider offices rarely know if they are in or out. The carrier websites experience lag which means even they are not 100% accurate.

If you want up to date information you will need to CALL the carrier and ask.

 

[straightnochaser]

I’m having issues with doctors showing up as not in network for many plans with different companies. Not showing on quoting tool, not showing on carriers own look up, etc. Sometimes I’ll call the doctor and they’ll say Yeah this doctor is accepting this plan or they’ll say “we can’t tell you, you have to call the insurance or look on their website”. Ive been give tax IDs by doctors offices and told to call insurance companies, and then the insurance companies say they have no way to look up by tax IDs.

Most recent was a person who has been going to the same doctor for years. Dr retired, and now no other doctor is showing up as in network for the same doctors office. Yet I call the doctors office and they say “yeah they all accept this insurance”. Who am I supposed to trust here? The doctors office or the insurance search? Why wouldn’t the insurance own provider search tool have correct information??

Im getting massive headache just dealing with if doctors are in network alone because every time one isnt showing up, I dont know if thats true or not. Is there a tried and true method to solve these issues? Im trying to reduce my phone hopping.

If they aren't showing in the carrier portal what makes you think they are in network?

 

[Fisher]

Im getting massive headache just dealing with if doctors are in network alone because every time one isnt showing up, I dont know if thats true or not.

Stop right there - that is all the truth you need. Don't stroke out trying to create a solution that doesn't exist.

[Source - I well remember those days.]

 

[jack3454]

If they aren't showing in the carrier portal what makes you think they are in network?

I mean I guess they could not be in network, but only one doctor in the practice accepting a huge plan in the area yet not one other doctor in the same office? It didn’t seem plausible to me.

 

[jack3454]

Stop right there - that is all the truth you need. Don't stroke out trying to create a solution that doesn't exist.

[Source - I well remember those days.]

True, thanks. It’s just all the other options increases their drug costs dramatically, this one plan covers all their drugs at $0 copay so I was trying to work this out for them.

 

[jack3454]

Once upon a time . . . in the early days of managed care and before Algore invented the internet, carriers published network directories printed on dead trees.

The directories were outdated before the ink was dry.

Fortunately for my clients, none of them have to worry about who is in and who is out of network. But for the rest of the folks, you can rest assured that you and your clients will go crazy trying to get a correct answer.

The par/non-par game changes so rapidly that the provider offices rarely know if they are in or out. The carrier websites experience lag which means even they are not 100% accurate.

If you want up to date information you will need to CALL the carrier and ask.

Calling the carrier was useless. They read off a script and check the exact same tool I was using.

Honestly it seems like nothing is updated. The drs website says we accept all Aetna Medicare plans, The carrier search says no one is in network, the drs office staff say they can’t tell me if a doctor is covered. Ugh.

Im just gonna move on and see if they can find another Dr that actually is showing as in network.

 

[DonP]

I mean I guess they could not be in network, but only one doctor in the practice accepting a huge plan in the area yet not one other doctor in the same office? It didn’t seem plausible to me.

That’s incorrect . Sometimes one dr in a practice only shows up yet I write it . Never had an issue to this day of the other drs in office not taking it .

 

[thomasm]

Is the doctor's office facility in network? If it is, and the doctor not showing up is W2 employed, then they are in network. I find this happens a lot when people give me the name of their PA, instead of their actual PCP.

 

[Fisher]

Is the doctor's office facility in network? If it is, and the doctor not showing up is W2 employed, then they are in network. I find this happens a lot when people give me the name of their PA, instead of their actual PCP.

Oh, I 100% agree with that. When Jack said 'doctor' my brain went straight to MD or DO and didn't even stop to think about a PA or NP. Good possible catch, thomasm.