I'm going to cry ... insurance related issue WWYD

cmw&tdm

Over Easter weekend we had to take DS to the ER b/c he was limping after tripping on something and I wanted to make sure he was okay.  So we go to the hospital that DS's pedi is affiliated with.  We go in, wait, and we are seen by an ER doc for less than 5 min.  He came in, saw him walk, and said keep an eye on it it's not fractured.  That's it.

Today we got an EOB from our insurance and we apparently owe $415 to just the ER doc.  The part we owe to the hospital is not too much at all.  I call our insurance and they tell me that it's so high b/c the ER doc is out of network and they have no control over that.  I don't get it.  The hospital is in network, but *some* of the ER docs are not.  So I'm supposed to walk in the ER and say I only want to be seen by ER docs that are covered under my ins?  Ridiculous.  Anyway, they gave me the ER doc's number and said I could tell them that I refuse to pay over the in network amount. 

 I'm so upset.  We have really good insurance and I have never found a doc that wasn't under our plan.  It's not fair for them to pull this on us.  If the hospital is under our ins the docs should be too, kwim? 

There is a small chance they won't bill us the whole amount, but I have my doubts. 

WWYD?

 

tina623

I had a ENT look at me and tell me I needed to be seen by someone else.  He turned out to not be covered by insurance because I didn't get referral.  The dr bill was very high.  I told him issue and also reminded him that he didn't really do ANYTHING to help me. 

He charged me $25 (down from $150).  I would talk to the dr, see what you can do. 

MewMew

Oh man, that sucks. We had something like that happen with our first IVF. We went to Cornell, was told by our ins and the dr was covered. We knew we would have to pay ahead and then get reimbursed. Well, the day they were going to order my meds we found out the that the facility was not covered. So um, where was I supposed to be treated? The street right outside??? Of course when they bill the put the facilitys name.

It's a bunch of insurance mumbo jumbo, if you ask me.

I would call the dr and see if they can work something out with you. Good Luck!

manda429

this happened during my delivery.  Some doc who I never met consulted on my anesethia.  Turns out he's out network and I have a huge bill to pay for him. Every other doctor and treatment was covered by insurance. I guess I'll take PP advice.

jlc071903

You need to appeal this. if the hospital is  IN-Network, so should all the Dr's, I had this issue with my hospital that I had my c/s at. Apparently they have some weird special  nursing staff/co that does c/s ONLY and they are out of network, SO my ins. billed me something like $3k....I argued with them and they eventually paid it b/c my argument was legit....if they are going to consider a hospital IN-NETWORK, than all the staff w/in the hospital should be covered.

LuckySunshineBaby

I agree with pp, i would appeal this.  During DD's delivery, I received a bogus bill from a group out of Atlanta (we live and delivered in jersey).  It included the Hearing test the state requires, a neonatal specialist on-call (she did not see one nor need any special assistance at birth) and several other charges.  I called my insurance company, they sent me an appeal.  The hearing test was bogus, just an attempt by the hospital to recover the mandatory test they must administer from either me or my insurance.  A former nurse in the billing dept. clued me in to this trick.  The rest, my insurance company eventually took care of and/or settled with the practice after the appeal. 

GL

SkypekWithoutAC

jlc071903:

You need to appeal this. if the hospital is  IN-Network, so should all the Dr's, I had this issue with my hospital that I had my c/s at. Apparently they have some weird special  nursing staff/co that does c/s ONLY and they are out of network, SO my ins. billed me something like $3k....I argued with them and they eventually paid it b/c my argument was legit....if they are going to consider a hospital IN-NETWORK, than all the staff w/in the hospital should be covered.

 This, I actually just had something really similar happen back in Feb. I went to the In-network ER and was seen by an out-of-network doctor, who billed me $230. I had actually already received a letter from the insurance company saying to send them the bill if I received one. I sent them the bill, and they sent me a check for $230. Definitely appeal. GL!