Legal Question in Health Care Law in Tennessee

md office lied about referral

my pcp referred my son to a pediatric cardiologist after finding he had a heart murmur. i told them to make sure that the ped. cardiologist was in my insurance network. they told me that he was and it was okay for me to take my son to see him. i am now recieving a bill from this md. i called my insurance company to find out that my pcp sent the referral in a month later than the appointment and that it was denied because he (cardiologist) wasn't in the network. am i responsible for this bill or should my pcp have to take care of it since it was their fault. what are my rights? thank you in advance for any thoughts on this.


Asked on 7/29/05, 11:45 am

1 Answer from Attorneys
Dr. Michael A. S. Guth Tennessee Attorney at Law Assists Pro Se (without a lawyer) Parties

Re: md office lied about referral

It sounds like the PCP is at fault. Why don't you call your HMO and complain that the PCP did not do his job properly, and ask the HMO to pay the cardiologist bill out of their profits -- or at least negotiate payment for an insurance carrier rate, which is always less than the amount charged to the general public.

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Answered on 7/29/05, 11:54 am


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