None of my doctors in

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PostPosted: Tue Mar 31, 2009 8:34 pm   Post subject: None of my doctors in  

None of my doctors in Charleston SC have ever heard of Cinergy health insurance. Is it because it is so new here? Would that be why no one knows if they are in-network with them?

Katie
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PostPosted: Wed Apr 01, 2009 1:47 am   Post subject:   

Hi Katie, welcome to the forum!



You should have been provided a document that lists the providers that are included within your network. If you have recently moved, get ahold of your human resources department to get a copy of this document for your new area.



If you can't get ahold of it, oftentimes the insurance company will have a geographical list of providers shown on their website. There's an option to look into. Here's Cinergy's website, and they'll ask you for your member ID and zip code.



cinergyhealth.com/



As far as the doctors "not knowing" if they're part of a network, there's a way this could happen, but first let me explain a couple of things. Assuming that you have PPO coverage, there's a lot of misunderstanding out there about PPOs. First of all, they're not insurance policies. They're what's referred to as "healthcare service contracts" and there's a difference.



Cinergy will go out and enter into contracts with various healthcare and healthcare affiliated providers to provide services to their subscribers at an agreed-upon, discounted rate for those various services. The contracted providers include hospitals, clinics, doctors of all types, alternative services such as free-standing surgery centers, urgent care facilities and a bunch of other medical provider types. The providers are paid based on the contract with the PPO for any services rendered. What you have to pay, in addition to the premium, will vary based on the plan you have purchased or are covered by.



So, the contracted providers are (or should be) aware that they are within the network, because they have signed contracts. The key here, and I think you nailed it, is in the communication TO the providers. They might be in the network and simply don't know it yet because Cinergy (as you stated) is new to the area, and the information hasn't yet trickled down to the bottom-feeders in the healthcare chain.



So, I think your best bet is the company's website to start. That, depending on how quickly their web geeks update the site, may or may not be your solution. Next I would try a phone call directly to the carrier. There's gotta be an 800 number somewhere on their site.



Good luck on your search. I've seen this before, so don't worry. I would bet it's a paperwork/communication issue.



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PostPosted: Wed Apr 01, 2009 7:28 am   Post subject:   

Okay, my question might sound dumb, but how is it possible that the doctors have signed the contract with the company and don't know about it? They might have gone through the contract paper before signing, right? Then, is it possible that the company name escaped their eyes? Even if we agree that one of the network doctors must have missed the name of the company, how come all of them didn't notice it?



Katie, I'd suggest that you stay away from the company which doesn’t have a proven track record in the area. You might get stuck with claims if the doctor denied to recognize the policy later on.


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PostPosted: Wed Apr 01, 2009 12:29 pm   Post subject:   

Hi,



Quote:
Then, is it possible that the company name escaped their eyes?




May be they'd all get updated with the next version of their network directory. It's just that the name has been added to their network list and it's yet to be published.

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PostPosted: Wed Apr 01, 2009 6:06 pm   Post subject:   

Quote:
Okay, my question might sound dumb, but how is it possible that the doctors have signed the contract with the company and don't know about




The individual doctors, etc. don't sign the contracts. The contracts are signed by the "bosses" of the hospital, clinic, etc. There's a good possibility that since the company is new to the area (which would indicate that these are "new" contracts) that the information has simply not filtered down to all of the employees. The rank and file might simply not be aware that the contracts are in place. This does happen in this world. Communication can, at times, be an issue!



Quote:
Katie, I'd suggest that you stay away from the company which doesn’t have a proven track record in the area. You might get stuck with claims if the doctor denied to recognize the policy later on.




Just because a company is new to a particular geography it doesn't mean that they aren't a good, proven company. If a provider has signed a contract with Cinergy, they have to honor the agreement. Contract law and all that stuff!



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