Medical procedure + out of network providerquestion

[firstbaby]

I’m soooo annoyed. DH had a colonoscopy a few weeks ago and it’s a doctor he really likes / trusts. To get scheduled for the procedure, he had to have a telemedicine appointment with doctor, doctor submitted for scheduling, he went to office for prep kit and then day of procedure. Our insurance stayed the same the whole time. A couple weeks ago, we got a “bill” from the anesthesiologist and they said our insurance had processed the claim and we owed $4800. Based on the coverage we have had for other procedures, I knew something was fishy. I logged into our health insurance portal and it showed it was still processing. DH called the anesthesiologist’s office and the billing person said that the statement was a mistake and ignore.

Yesterday, I got an email that the claim has been processed. Log in and the bill for the anesthesiologist is over $500. He was out of network, but the doctor was in network. I am SO ticked. DH didn’t choose the anesthesiologist and that person being out of network feels really sneaky. I want DH to call the doctor’s office (doctor who did the colonoscopy) tomorrow and ask them to explain. Anyone BTDT and was anything additional worked out?

[PZMommy]

I’m soooo annoyed. DH had a colonoscopy a few weeks ago and it’s a doctor he really likes / trusts. To get scheduled for the procedure, he had to have a telemedicine appointment with doctor, doctor submitted for scheduling, he went to office for prep kit and then day of procedure. Our insurance stayed the same the whole time. A couple weeks ago, we got a “bill” from the anesthesiologist and they said our insurance had processed the claim and we owed $4800. Based on the coverage we have had for other procedures, I knew something was fishy. I logged into our health insurance portal and it showed it was still processing. DH called the anesthesiologist’s office and the billing person said that the statement was a mistake and ignore.

Yesterday, I got an email that the claim has been processed. Log in and the bill for the anesthesiologist is over $500. He was out of network, but the doctor was in network. I am SO ticked. DH didn’t choose the anesthesiologist and that person being out of network feels really sneaky. I want DH to call the doctor’s office (doctor who did the colonoscopy) tomorrow and ask them to explain. Anyone BTDT and was anything additional worked out?

I had something similar. When I had my c-section, they sent my placenta to some lab for testing as I had many issues with that pregnancy. Of course I had no clue they were sending it in, and didn't choose the lab they sent it to. I got a rather large bill for it. I called my insurance company and it was prompt taken care of.

I would definitely make some calls and I bet you will be able to win this one.

[SnuggleBuggles]

That sucks. NPR has an occasional segment on issues like this and they are so common. And hard to fight. link to past segments https://www.npr.org/series/651784144/bill-of-the-month
eta- there are more related when you go to the Kaiser Health Network links on there too https://www.npr.org/sections/health-...-10-times-more

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[ahisma]

This is somewhat common with anesthesiologists. Depending on what state you live in, there may be provisions prohibiting it. It's called surprise billing or balance billing. https://www.freep.com/story/money/bu...an/6045348002/

[NCGrandma]

This is somewhat common with anesthesiologists. Depending on what state you live in, there may be provisions prohibiting it. It's called surprise billing or balance billing. https://www.freep.com/story/money/bu...an/6045348002/

In NC, there have often been issues specifically with anesthesiologists. At one time, basically all the anesthesiologists at a large hospital were out of network for most patients (and the anesthesiologists used the resulting outcry to negotiate a better deal with the hospital). Not sure what the current laws are about balance billing.


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[ahisma]

In NC, there have often been issues specifically with anesthesiologists. At one time, basically all the anesthesiologists at a large hospital were out of network for most patients (and the anesthesiologists used the resulting outcry to negotiate a better deal with the hospital). Not sure what the current laws are about balance billing.

Yep - there are a few specialties where this tends to be more common. Radiology, pathology, and ER physicians are common areas as well. Air ambulance is a massive doozy - they are FAA regulated and there are basically no cost controls. My kids know that there are things that I won't let the do (jump from trees, etc.) when we're in an air ambulance only area.

[Octobermommy]

Don’t call the doctor. It won’t do any good. They may not even have any say on the anesthesiologist on the case. The hospital usually assigns anesthesia to cases. If you want change I would call the hospital & ask them
To offer contracts to groups who are in network with major insurances or call the anesthesia group & talk to them about it or call your insurance. Your insurance is the one with the most power- they decide what amount they will pay in network providers.

You can call a lot of people that can do better or different but the performing doctor isn’t the one that has any control. They would likely just say “sorry”. They aren’t going to pay your anesthesia bill & they probably wouldn’t have any pull with the anesthesia office to knock money off the bill.

I’m sorry , it stinks.

[firstbaby]

Don’t call the doctor. It won’t do any good. They may not even have any say on the anesthesiologist on the case. The hospital usually assigns anesthesia to cases. If you want change I would call the hospital & ask them
To offer contracts to groups who are in network with major insurances or call the anesthesia group & talk to them about it or call your insurance. Your insurance is the one with the most power- they decide what amount they will pay in network providers.

You can call a lot of people that can do better or different but the performing doctor isn’t the one that has any control. They would likely just say “sorry”. They aren’t going to pay your anesthesia bill & they probably wouldn’t have any pull with the anesthesia office to knock money off the bill.

I’m sorry , it stinks.

The procedure was done at the doctor’s office, not a hospital. That’s one of the reasons I’m so angry. The doctor was aware of our insurance and should have either advised DH the anesthesiologist was out of network or offered an in network provider.

[firstbaby]

Thanks, everyone, for the advice and commiseration. DH was told when he called the anesthesiologist’s office about the fake bill that the most we would owe was $250. He will be busy calling the two doctor’s offices tomorrow and I will call our insurance. It’s a PPO and they’ve been great to work with so far.

[ahisma]

Thanks, everyone, for the advice and commiseration. DH was told when he called the anesthesiologist’s office about the fake bill that the most we would owe was $250. He will be busy calling the two doctor’s offices tomorrow and I will call our insurance. It’s a PPO and they’ve been great to work with so far.

I think your PPO may be your best bet - although not a sure bet. I work for a coverage plan and we did pay - but it was a matter of principal for us, it wasn't officially a covered benefit (even though we watched for it and covered it). In our area, there was only one anesthesiologist group...so we were stuck.

We tried - very, very hard - to get an agreement with some of these practices. It wasn't something they were willing to do.