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The Kansas City Star, Mo., Angela D. Curry Column: Don't Depend on Doctor for Insurance Answers

Posted on: Thursday, 1 June 2006, 18:00 CDT

By Angela D. Curry, The Kansas City Star, Mo.

May 28--A t Your Service: In March 2005, I called the office of Dr. Jeffrey MacMillan. I wanted to know if he was a member of the Advantra health insurance network and accepted Advantra insurance patients. The answer was yes. I made an appointment for March 28, 2005.

At my appointment, I inquired again if the doctor accepted my Advantra insurance and was told yes. The receptionist made a copy of my membership card, and I paid the $30 co-pay for the office visit.

Weeks later I was notified by Advantra that the doctor was not in their network and therefore the office visit was not covered (a $300 charge).

I received a statement and a phone call from the doctor's office. I told them that on two occasions I had asked if the doctor was in network and whether they accepted my insurance. I acted in good faith and feel I am not responsible for having been misinformed and misrepresented.

I'm now working through Capital Accounts of Nashville. I sent them a certified letter with an explanation. Capital has filed a report with the credit bureau. I have excellent credit and feel that we are not responsible for this bill. -- L.P., Overland Park

Dear L.P.: Jeffrey T. MacMillan's office explained that because of health care privacy laws it could not provide specifics about your case. Office manager Annette Vega explained that during the time your appointment was made the office was a Coventry provider but not an Advantra provider.

Advantra is a Medicare HMO offered by Coventry Health Care of Kansas Inc.

Vega said the office had contacted Coventry Advantra about this matter and was told that Coventry Advantra members are fully informed it is their responsibility to verify provider's eligibility. This could be done by contacting the company's customer service, referring to the provider directory, or verifying the information online.

Vega said the office staff would never intentionally misinform a patient or misrepresent its practice. Vega said she understands your concerns and had tried to find an applicable resolution to this matter; but was unable to.

We want to remind consumers that they should double-check with their insurance companies regarding covered services and in-network and out-of network services. Some companies offer the option of out-of-network benefits to fill specific needs of the patient. This allows patients to choose physicians that are not in the network, with the patient's financial responsibility being higher than if choosing an in-network physician. Don't rely on the doctor's office to tell you whether you are covered or not.

Dispute resolved

Last Sunday we ran an article concerning J.O. of Overland Park and her dispute with Father & Son Moving & Storage in North Kansas City.

The dispute has been resolved. J.O. signed a claim settlement with the company on May 15.

J.O. had asked the company to reimburse her for damage to a dresser and for a stick vacuum cleaner that was lost. The company said it had no information that the vacuum was on the truck and that J.O. had signed a waiver of a detailed inventory of her belongings and a bill of lading, which acknowledged that her property had been received in good condition and that the truck was inspected and all goods were received.

The company offered J.O. its final settlement of $315.48 and said she had 10 days to accept the offer or it would be rescinded. We did not learn of the settlement until after the column appeared in MoneyWise.

At Your Service appears Tuesdays and Thursdays in FYI and Sundays in MoneyWise. At Your Service solves problems when your best efforts fail. Send your request for help to At Your Service, The Kansas City Star, 1729 Grand Blvd., Kansas City, MO 64108, or send e-mail to acurry@kcstar.com . Phone calls cannot be accepted. Please plainly print your name, mailing address and phone number with your request. If we use your letter, we'll print only your initials and city.

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Copyright (c) 2006, The Kansas City Star, Mo.

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Source: The Kansas City Star (Kansas City, Missouri)

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