Re: Epidural Cost, in/out of network

KellyLouise... · October 2009

So, I just called my insurance co. to check on this. I was told that that most anesthesiologists are not in-network but there is a clause in my policy that states of "x" exists than all physician fees are considered in-network due to "x".

Basically, because I cannot choose who administers my epi it will be considered in-network regardless of physician status.

So, I would call your ins. co to see what your policy covers. I was concerned for a minute there. I have budgeted for my out of pocket max all in-network.... anything above that would definitely impact my financial well-being!

Ncaminiti · October 2009

the only thing is if doctor isn't in network he has no contract saying he accepts the insurance fees. I have heard of MANY people still having to pay the difference to the anesthesiologist because there fee is higher then the insurance allowed fee.

lschu · October 2009

I work in insurance. Just as a heads up even if you have the clause that states that they will be paid in network if the anesthesiologist is not in-network normally with insurance they can charge above the "allowed amount" by the insurance company and you will be responsible for the addiitonal out of pocket. For example they charge 1000.00 and the insurance allows 500.00 and pays that at 100% they are only paying their allowed amount a 100% and treating them like an in-net provider. The additional 500.00 is usually write off for contracted providers but since they aren't in-net or contracted they can bill that to you. Be aware this is very common and can put your out of pockets up by a LARGE amount. I have seen this happen too many times. Just a heads up so your not surprised I go over this daily with customers.

Nicole731 · October 2009

Ditto to the two ladies above me. Your insurance carrier will pay them the in-network rate. But if they do not have a contract, they have every right to bill you the difference of what they were paid and what their charge is. And doctors can charge whatever they want for their services, just like everyone else. We have some doctors that we work for that charge 5 times more than most insurances pay.