Members play a part. We play a part. At some point we're all connected in trying to coordinate the member's care. It's our responsibility to let the member know. The member usually knows whether the doctors are in network or not.
Most people know generally what their benefits look like.
But many members don't fully understand their contracts with managed care groups, and often physicians have to guide them, Dr. Tharp said. The insurance company is generally felt to be responsible for educating the members. In most cases, they do have meetings and tell people these basic rules. In the end, it's likely the patient who will get stuck with a bill if the insurer doesn't pick up the tab because no one sought authorization for a service. And that means the physician will have to go after the patient for payment.