Bill Payment

It sounds as if your doctor is not a contracted provider under your insurance contract. If that is the case the doctor is not subject to the insurance company, the insurance company's rules, regulations, policies and procedures have no jurisdiction on the non-contracted provider. Therefore, the non-contracted doctor has no legal obligation to send a claim, receive payment from the insurance company, or appeal a denied or partially paid claim. Everything reverts to the contract between the patient and their insurance company. That contract requires the patient to submit their own claim, however they can decide to submit a claim but it is only as a courtesy to the member. If the doctor is contracted with your insurer they must submit your claim for you and this scenerio should be reported to your insurer.

Keep in mind if you are using a non-contracted provider you will be subject to higher out-of-pocket cost since they do not have a pre-negotiated rate with your insurer. PAF has a great publication on Usual, Customary and Reasonable Charges (UCR) a result from using an out-of-network provider/facility. http://www.patientadvocate.org/index.php?p=439