I hate insurance companies, and a PSA

august06mom

When your DC is in the NICU, make sure you ask each doctor who cares for them if they are in your network, even the ones who spend 30 seconds looking at them at 3:00 a.m. when you're trying to take a quick 20-minute nap in the chair outside. Because it could cost you $500 out of pocket if you don't.

EMT

I had the same thing happen with my epidural. They sent a doctor to my room that was not in my network (the hospital was in the network and my OB was in the network) even though they had my insurance info ahead of time. I guess you are supposed to ask the anethesiologist if he takes your insurance when you are in hard labor (OH AND send him away when he says he's not)? Ridiculous. The anesthesiologist eventually left me alone once my insurance paid him the contracted rates which was much less than he was billing me.

My OB's office suggested getting the hospital involved because that is who sent that doctor to my room (someone in the hospital effed up). I didn't end up having to do that but maybe it'd work?

august06mom

Thanks. I just contacted the hospital and asked for a reduction in my bill. The women is going to get back to me, but she said they may ask me to write a letter for a hardship request instead.

Ugh.

penguingrrl

You can definitely fight that. My SIL had that issue with her anesthesiologist after her first child was born. It turns out that there was only one anesthesiology group serving her hospital and they don't belong to her network, but the insurance still tried to charge out of network rates. It took time and effort, but she finally made it clear that since she had no choice but to use that practice it shouldn't be out of practice.

Ciarrai

You can fight it and argue. I had something similar happen with DD2 where they sent my bloodwork to a lab that was out of network. We just argued with the hospital that it was on them since they knew my insurance info anted they're the ones who sent off my bloodwork. They took it off my bill or at least gave me the in-network rate.

ridesbuttons

I cannot imagine the stress of dealing with medical insurance. 

Hats off to all of you and stick it to the man when you can.

I hate insurance companies as well.  Bloodsuckers.

august06mom

So what do you think I should say? Honestly, it never even occured to me to ask if each doctor was in-network. I assumed that as long as I was at an in-network hospital, I should be OK. (Never mind that we didn't have too much of a choice in picking the hospital since it was the only Level 4 NICU in the area, and the one that our pedi told us to go to.) When I explained that to the insurance company, the guy snootily said that, yes, I should have asked each doctor.

puggylove

We went thru the exact same thing with our son. He spent 2 weeks in the NICU and the neonatologists charged $850 a day to "look him over" (I know they did more than that but that's how I felt). Anyway, the company the doctors were contracted with were in-network but the doctors were not. The hospital was in-network. It took a very long 13 months for me to get a straight answer and find this out from the company. I finally went to our insurance company (stressed and in tears - because they were threatening to send the account to collections) and explained in detail the situation. The insurance company, finally listened, and sent all the claims back thru an expedited review and ended up paying as out of network and covered 90% of the charges. Our original bill from the neonatolists was around $12k and I think I ended up paying out of pocket max $500. Call your insurance company and get someone who will listen and explain that you went to an in-network hospital and had no control over the doctor who cared for your baby. Hopefully they will make it right. I'm sorry you are dealing with this, I don't wish it on anyone especially a new mom. (I'm on my phone sorry for no paragraphs)

EMT

I think that you should ask the insurance company to at least pay the doctor the contracted rates for that service (i.e. had he/she been in network what they would have paid). They most likely will not pay more than that (so any more arguing with the insurance company may be futile) but if the doctor accepts it, he is not allowed to continue to pursue you for the balance. At least that is what I was told by my insurance and that is what happened in my case.

I would ask the that the insurance company attempt to make a partial payment to the doctor and then call the doctor AND the hospital and pitch a fit about their role in all of this. That doctor never should have been sent to your room!

ridesbuttons

august06mom:

So what do you think I should say? Honestly, it never even occured to me to ask if each doctor was in-network. I assumed that as long as I was at an in-network hospital, I should be OK. (Never mind that we didn't have too much of a choice in picking the hospital since it was the only Level 4 NICU in the area, and the one that our pedi told us to go to.) When I explained that to the insurance company, the guy snootily said that, yes, I should have asked each doctor.

The insurance guy deals with insurance every single day.  You are a parent with a child in the NICU who is new to everything.  The burden *should* be on the insurance company to provide some guidance in such an extreme situation.  Failing that, the hospital that is making a profit should have some sort of patient/insurance advocate liason to help people navigate this nonsense.  Nobody takes a class on how to handle this type of emergency to prepare in advance.

Fcuk.  I'm the wrong person to be in this thread, but it pisses me off to no end to read these types of stories.

august06mom

Thanks everyone. I just spoke to the hospital again, and they said they were going to negate the charge. Yippee!!

ridesbuttons

Ciarrai

Keep pushing back at them. Tell them that you had no control over who saw your LO when he was in the NICU so being in or out of network was out of your control. Also if/when you come to an agreement on the cost, ask about a payment plan. Most hospitals will let you pay as little as $20 per month or less to pay off your bills without charging you any interest. They will ask you things like "if we gave you 20% off, could you pay it all right now?" and "do you have a credit card you could put this debt on or family members who could help you out?". Just say no. Then they'll ask you how much you can comfortably pay and you can tell them whatever you can afford. You can also use your HSA to pay for these costs if you or your husband has one through work. The $$ is pre-tax so you don't pay any income tax on them.

eclaires

I was going to say - talk to the hospital, not the insurance company.  In this case, it is the hospital's fault since they have your information.  It's not really the insurance company's issue - the hospitals take this risk when they accept insurances and employ doctors that are out of network for those insurances.

Glad you got the charge negated!

Cbidt's girl

august06mom:

Thanks. I just contacted the hospital and asked for a reduction in my bill. The women is going to get back to me, but she said they may ask me to write a letter for a hardship request instead.

Ugh.

do not write a hardship letter or agree to pay a portion. This is a billing issue. They can easily bill under another provider number in your network.

mommyof4boys

In the NICU you have no choice who sees your baby.  The hospital needs to assist in an appeal for you.  We had that problem when my twins and singleton were in the NICU.

A-baybride

This is common with anesthesiologists and ER docs.  They have absolutely no incentive to sign contracts with insurance companies because people using their services obviously don't have a chance to doctor shop and find one in their network.

Just to counterbalance the bloodsucking insurance stories, I actually have a couple positive experiences with this exact thing.  A few years ago I had to go to the ER and went to an in-network hospital.  The ER doc sent a bill (on top of the hospital's) for his services, and of course he wasn't in-network.  My insurance (Aetna) initially only paid out-of-network rates, but I called and explained that I went to a network hospital, and they paid the whole thing.

When I was pregnant with DS, we had Blue Cross.  When I called to find out what my maternity benefits were, she went through everything that was covered, then volunteered that if I wanted an epidural, since most anesthesiologists don't contract with insurance companies, that it would be covered 100% even if they weren't in-network.

So there are some companies that have some decency!  Keep pushing back on the insurance company and the hospital.  You did your part by going to a network hospital and it's unreasonable to expect you to grill NICU providers about their insurance affiliations! Honestly, I think this practice is more slimy and deceptive on the doctors'/hospitals' side than the insurance companies'.  I think for a doctor to receive privileges at a hospital, he/she should have to agree to bill according to the insurance contracts the hospital has signed.