Mis-representation

Hi
I recently had an MRI done which was referred by an in-network doctor. He supposedly referred me to an in-network facility. When I called up the facility they too stated that they were in-network. So, I made an appointment and they right before I went then, they again claimed to be in-network and that the procedure would be in-network. (and no they did NOT make the statement "we accept your health insurance". I am aware of this trap and would never fall for it)
Now, here I made two mistakes.
1.) I didn't get this statement in writing from them.
2.) I didn't check up with my insurance agents since both my doctor and the facility said that the facility was in-network.

However, a few days later, guess what? They are not, in fact, in-network and now I'm liable to pay for almost the whole cost of the procedure. And they've billed me nearly 9k for a procedure that typically costs about 1k.

Is there something that I can do in this situation? I'm thinking of getting a friend to call them up and get their claim of being in-network in writing. I'm sure that they will still make that claim.

Any help guys? I haven't talked to them yet but I'd like some advice on how I can proceed.

[Amir Mostafaie]

Dear mvud,

You haven't mentioned who is your insurer, but some insurance companies have multiple networks and while a provider may actually be contracted with 1 of their networks, they may not be part of the others. So if this is the situation, the provider has not necessarily misrepresented itself. However, if your insurer has only 1 provider network and your provider claimed to be in that network, you may have a case. You will need to provide the name of the individuals/representatives that made the false claims to the management of the facility & ask to be charged the negotiated rates as if they were in-network providers.  

Another thing to keep in mind is that most plans require a pre-authorization for an upcoming procedure which is typically done by the provider; especially for a $9K procedure. You can find out from your carrier if there any notes in your account regarding this pre-authorization which you can use in case you enter litigation.  

For future reference, my advice is to ensure the validity of provider’s status with the carrier instead of the provider and document the name of the carrier representative, date/time and the phone number you used to reach them. That way the carrier/insurer will be responsible.

Sincerely,

Amir Mostafaie