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Out of Network Neonatologist

monkeyroomonkeyroo
in Preemies

I need some advice.....

 My son was born 35w2d and had to stay in the NICU for 5 days.  We finally have all of our hospital bills rolling in, only to realize that the neonatologist that saw him each day was out of our insurance network.  We have no out of network coverage, so we are responsible for the entire $2600 charge.  On top of that, we have a $2500 deductable that is already being charged from the hospital (the neo is charged from a separate location.)

 

We were expecting to only get stuck with our $2500 deduct, but now have this other enormous charge.  There is no way we can afford this.  Has anyone else been in this situation, and what can I do about it?  I really don't want to have a collection on our credit, and am starting to lose sleep over this!!  Help!

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Re: Out of Network Neonatologist

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    LuckyMom0203LuckyMom0203

    Ugh, dealing with a mess like this is the worst-- and so stressful.  I think it's odd that the hospital didn't inform you about the doctor being out of your network.  With all the random doctors, tests, procedures, etc. that babies experience in the NICU, it's impossible for the parents to keep track (or even know initially) what is in their network and what isn't.

    The first place I would start is the hospital.  Most, if not all, hospitals will work with you on lowering a bill.  I would definitely emphasize that you didn't realize at the time that the doctor was out of your network.  You'll have to fill out some paperwork and provide some info. on your finances but then you can submit it and request to only pay a percentage of your overall bill.  Also, I've definitely learned that the squeaky wheel gets oiled in circumstances like these-- talk to many different people, ask about any available options and be persistent.

    I would tell you that the next place to go is with your insurance company and I suppose you can write an appeal letter to them.  I have never found this to work.  My insurance company has always been less than helpful.

    Also, there ARE assistance organizations out there for this kind of thing.  Ask your hospital if they know of any, ask your child's pediatrician and do some research.  

    Last, but definitely not least, appeal to the actual doctor.  Many doctors, once they realize that there are insurance issues, will try to cut you a break.  

    I know this sounds like a lot of legwork, but usually it pays off.  I'm sure you'll be able to get at least a reduction in your bill if you try enough different avenues.  Good luck (I definitely know how stressful this can be) and keep us posted on your progress!

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    meldoo2002meldoo2002 member
    I had to write an appeal letter to my insurance company to have our NICU bills paid because the neos were out of network.  Craziness seeing the hospital was in network.

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    bhaynietippittbhaynietippitt member
    This happened to us as well. I filed a grievance with the insurance company stating that this neonatology group was the only one that served the NICU, therefore I did not have the option of using an in-network provider. They then paid the claim. Good Luck!
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    Heather1979Heather1979 member

    imagebhaynietippitt:
    This happened to us as well. I filed a grievance with the insurance company stating that this neonatology group was the only one that served the NICU, therefore I did not have the option of using an in-network provider. They then paid the claim. Good Luck!

    This, exactly. If you don't have a choice in practitioners you need to identify that to your insurance company.

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