Anesthesiologist and insurance HELP

Re: Anesthesiologist and insurance HELP

• Mskris66 member

  February 2014

  Coincidentally enough DH is in the medical field and we are investing in an anesthesia company in the next week or two. To my knowledge (I will double check with him in the am) anesthesia is one of those things that can't really be denied. If the procedure taking place is mandatory/covered, you cannot deny the anesthesia portion of the procedure. A lot of docs are out of network for something like this, so what will normally happen is your insurance will cut the check to you, and then you will have to pay the anesthesiologist. They are just not allowed to cover it directly if they are out of network.

  
  

  
  
  

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• Zriseon3 member

  February 2014

  My insurance made it a point to print in the explanation of benefits that they will not cover an out-of-network anesthesiologist and that I have to be the one to make sure they are in-network. The problem is that I have no control over who it will be. I guess I will call the hospital and see if how they handle that.

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• eMac87 member

  February 2014 edited February 2014

  I am in the same situation. My insurance only covers in network anesthesiologists. I plan to go med free but in case something arises I don't want to be stuck with a large bill.
  
  I have 100% maternity coverage but my insurance warned me about this. I'm glad I called and found out I'm advance.
  
  I hope someone has the answer to this questions!

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• Stephout member

  February 2014

  Now I am freaking out and want to call insurance. I really hate how health care works with no transparency and often no alternatives. And my insurance and disability stuff needing all this paperwork right after I pushed out a tiny human. And my stupid company replacing my plan and essentially making me pay 2k more than I would have if we had the baby last year. Ugh.

  

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• Zriseon3 member

  February 2014

  I'm going to ask around and see what I can find out. Anybody else that does the same please come back and update us. So far my research has been mostly dead ends. I read that if they make note that you requested an in-network doctor even if there isn't one there it is easier to get the insurance to pay out. Others said that if your employer is a large company the HR dept should be able to get them to pay because the insurance doesn't want problems with their big clients. I'd rather not have to fight it at all though. So if anyone has any answers please let us know. Thanks.

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• klitwin1 member

  February 2014

  You can talk to your employer as they are the ones that decide what benefits are covered not the insurance company. If they don't cover oon doctors see if they will grant an exception for this delivery as you have no control of whether or not they are in network. This happened to me with my first and I was balanced billed 5k my employer told bcbs to pay it and I only had to pay the 10% coinsurance

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• eMac87 member

  February 2014 edited February 2014

  So I called my insurance and they quoted me what it would cost out of pocket and they said they would cover anything after $2500 (obviously this varies by insurance).
  
  I am on my husbands insurance but I asked my benefits person and they never had a request to change a coverage policy for one person.
  
  I called the maternity ward at my hospital and they transferrd me to the anesthesiology dept and I told them my insurance (Anthem BCBS) and they were able to confirm that all of their docs were in-network with my plan. So I feel like your best bet is to call your hospital.
  
  They also gave me the heads up that if your pediatrician doesn't work at that hospital to make sure that you only request in network pediatrians only.
  
  Make sure your SO or labor partner is available to communicate this to the nursing staff and they have it all on record.

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