When you book a Verified In-Network Appointment through Zocdoc, we want you to book with confidence. That’s why Zocdoc is offering the In-Network Promise Program, which provides a way to request a review and possible customer service payment if you receive an out-of-network bill after booking a Verified In-Network Appointment through Zocdoc. The In-Network Promise Program is a discretionary, case-specific customer service program, under which Zocdoc may offer a payment based on the estimated difference between the amount you are responsible for paying out-of-network and the amount you would have been responsible for paying in-network. Zocdoc may offer a customer service payment only after reviewing the relevant facts under the guidelines below. Any payment is discretionary, case-specific, and not guaranteed. This is not insurance, a warranty, or a healthcare benefit.
What is a Verified In-Network Appointment?
Verified In-Network Appointment means an appointment for which (i) a user’s insurance information was verified through Zocdoc’s insurance verification technology, (ii) based on such verified insurance information and information available to Zocdoc at the time of booking, Zocdoc identified the applicable provider as in-network with the user’s verified insurance plan, (iii) the user subsequently booked an appointment with such provider using the verified insurance information, and (iv) the user completed such booked appointment using that same insurance selection.
1. In-Network Promise Program Factors and Guidelines
If you receive an out-of-network bill after booking a Verified In-Network Appointment, you may contact Zocdoc to be considered for a customer service payment under the In-Network Promise Program. Zocdoc may consider the following factors, together with other relevant facts available to it. These factors are guidelines for a case-specific review and do not create a right or entitlement to a payment.
Whether the appointment was booked through an eligible Zocdoc booking channel, which includes bookings made on the Zocdoc platform after logging in or creating a Zocdoc account.
Whether you provided sufficient and accurate information for Zocdoc to verify your insurance information, and Zocdoc was able to successfully verify such insurance information at the time of booking by contacting your insurance carrier. The In-Network Promise Program does not apply if you have provided information about your plan, but we were unable to verify that information with your carrier. The In-Network Promise Program is not available for all insurance carriers. Based on your initial insurance carrier selection, Zocdoc will identify whether your insurance carrier may be included within the In-Network Promise Program.
Whether you accepted the insurance plan verified by Zocdoc during booking and completed your booking using that same insurance selection (the “Selected Insurance Plan”).
Whether, at the time you booked, the provider was listed on Zocdoc as in-network with your Selected Insurance Plan.
Whether your insurance under the Selected Insurance Plan continued to be active through the date of your appointment.
Whether you attended the appointment and received a bill from the practice for services rendered by the specific provider with whom you booked the appointment reflecting that the provider is not in-network with your Selected Insurance Plan. This is different from a bill indicating that:
You owe a payment to the provider directly due to your deductible or cost-sharing obligations;
Some or all of the services are not covered by your plan; or
The provider’s charges exceed your plan’s allowable amount and the provider is attempting to balance bill you.
Whether you contacted the provider directly before contacting Zocdoc to notify them that they were identified as in-network and gave them an opportunity to correct the bill.
Whether you were unable to resolve the issue with the provider directly and submitted your case through the “Report an Issue” function in your Zocdoc account within 60 days following the date of the first bill issued by the practice for the applicable services.
Whether, in all cases, you submitted your case no later than 6 months after the date of the appointment booked through Zocdoc at which the applicable services were rendered.
Whether you provided all requested information and fully responded to any follow-up requests by Zocdoc.
2. Customer Service Payment Guidelines
Based on a review of the information you have provided, Zocdoc may offer you a customer service payment equal to the estimated difference between the amount you are responsible for paying for the provider visit and the amount you would have been responsible for paying if the provider had been in-network with your Selected Insurance Plan, up to $1,000 per Verified In-Network Appointment, with a maximum of 2 approved customer service payments per person per calendar year and an aggregate annual payment limit of $1,999 per person. The amount will be determined by Zocdoc in its sole discretion based on the information reasonably available during its review.
If Zocdoc offers a customer service payment, it will process eligible customer service payments through Stripe, or a successor payment processor, to deliver the payment. To receive payment, you may be asked to provide payment information through a secure Stripe-hosted form. Stripe processes your information in accordance with the Stripe Privacy Policy. Payment may require the user to complete Stripe’s verification process. Zocdoc may provide an alternative payment method, such as a Visa Gift Card, at its discretion.
Zocdoc will not make payments under the In-Network Promise Program in connection with:
copays,
deductibles,
coinsurance,
services not covered by your insurance plan,
charges denied because of prior authorization, referrals, or medical necessity requirements,
cancellation fees,
no-show fees,
administrative or practice policy fees,
laboratory, imaging, pathology, anesthesia, or other services not provided directly by the provider with whom you booked the appointment,
prescription medication costs, if ordered during your visit,
follow-up appointments not booked through Zocdoc,
amounts already reimbursed, waived, refunded, or paid by another party,
duplicate cases, or
charges related to billing errors or disputes between the provider and insurance carrier unrelated to whether the provider was in-network with the Selected Insurance Plan.
3. How to Report an Issue
If you received an out-of-network bill after booking a Verified In-Network Appointment and have been unable to resolve it with the provider, please use the “Report an Issue” function within your Zocdoc account and provide any documentation requested by Zocdoc. This must be completed by the individual who booked and attended the appointment or an authorized representative. More information on how to “Report an Issue” for the In-Network Promise Program can be found here.
4. Additional Information
Zocdoc may modify, suspend, or discontinue the In-Network Promise Program at any time at its sole discretion. The In-Network Promise Program is a voluntary customer service program for users of the Zocdoc platform. It is not insurance, a warranty, a healthcare benefit, a guarantee of insurance coverage, or a promise that every reported issue will result in a customer service payment. The In-Network Promise Program is personal to the user and may not be assigned or transferred. Zocdoc determines the customer service payment at its sole discretion. The user remains responsible for resolving and paying any amounts owed to providers. Any payment from Zocdoc does not relieve the user of those obligations. The user remains responsible for determining how to pay any amounts owed to the provider. Zocdoc does not consider or inquire into a user’s chosen method of payment, including whether the user uses an FSA, HSA, or other tax-advantaged account. The user remains responsible for their own tax-advantaged account compliance or other tax obligations.