If a doctor says they take my PPO, but my PPO's find a physician tool doesn't list them, I should believe the tool, right?
@tindall No, I'd probably call the insurance company. I've had a few situations where the tool was stale.
@tindall Generally yes, but some healthcare places will mark on the claim the physician who is listed (assuming one is) even if you see someone else. Unfortunately those tools also might have bad data so you may need to call the insurance company as well to at least verify that your insurance claims have impure and nondeterministic results.
The doctors know that whatever they can't bill to insurance is going to be written off, so they won't lie about what's covered. Even though they have you sign the form that says you're responsible for any treatment that's not covered, they still need to be honest about coverage issues in order to have that hold up in a court
There are a number of games being run in the back office to cope with the power differential between doctors' offices and insurers and these mean the insurance company's view of the provider network may be radically different from reality