I had been referred to the Headache & Pain center in Leawood, KS by a friend/neighbor for treatment of a pinched nerve in my upper back. We selected the H&P center based on the fact that they were a preferred care provider in our medical insurance network. The specific doctor that we worked with, Dr David Bankston, was also a preferred physician in our network which qualified all treatments for the highest level of coverage.
I scheduled an appointment and started to receive treatment from the center on 5 separate occasions over the next two months. Each of these visits were covered by our insurance provider and we promptly paid our copay and all other bills on a timely basis.
On Oct 11th at the final treatment for the pinched nerve, I let Dr Bankston know that I was no longer suffering any pain from it. I did however have some pain in my shoulder. Dr Bankston recommended that I receive an MRI to be sure there were no further injuries. We checked with our insurance carrier as we could not afford the $1,500 or so in charges and found that we would only be charged the copay as in our other visits. The MRI was scheduled for and completed on Oct 18th.
After the MRI was completed and billing was processed a few weeks later, we were notified by our insurance carrier that Dr Bankston had let his participation in our insurance group lapse on Oct 15th. This meant that he was no longer a preferred physician. As an out of network physician all copays and deductibles from the Oct 18th appointment were now negated and we would be responsible for all charges for the MRI.
We were not made aware of this fact either prior to, the day of or following the procedure. However, the day of the MRI, the H&P Center did take our insurance card and copay amount but did not see fit to tell us about the changes in Dr Bankston's status. The insurance company said that it is the responsibility of the physician and the billing office to notify all patients of a change such as this. I do not fault the insurance carrier in this instance.
We have since tried to contact both Dr Bankston as well as the billing office at H&P but to no avail. They only ask if we are ready to settle in full. When we begin to explain the circumstances and seek resolution we are told that the claim has been passed on to their legal department and is out of their hands.
We did issue payment for all bills that would have been outstanding had insurance been paid so there has been no financial gain for us in not making payment.
However, today, 5/12/06, the sheriff delivered to us notice of a lawsuit claim against us by the H&P Center for the amount of $2,800 as well as all legal costs associated with the collection.
My wife and I are 45 years old and we stand proud that at this point in our lives, we have never had to be a participant in a lawsuit or legal action and have never been in court other than traffic court for a moving violation. This is not how we settle disputes.
I just want to know how this could happen and what we should do to prevent it from happening again to others?
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