Billed for an out-of-network doc in the ER

[ILiveInFlipFlops]

Is there any way around this? I know that I've seen people here say that those kinds of things should be fought, but there are signs all over the ER saying that any provider you see that day might not be in your network.

 

So how does one fight this? I'm looking at a $557 bill, and I got a $370 one from radiology, which is weird, because I'm pretty sure my insurance has covered same office before.

 

Anyway, any advice/experience is very welcome. Also, how do I prevent this sort of thing from happening again? Can you tell the ER when you go that you don't want to see a urologist unless he's in your network or something? Will they get you someone else, or do they just tell you "tough toodles"?

 

I've never quite understood how all this stuff works :(

 

Thanks.

[Susan C.]

If the ER was in network, usually all you need to do is call and tell the insurance company. This has happened to us, and I said that it is impossible to ask each provider if they are in network. Once I had to write a letter stating that. Both times the bills were adjusted to in network rates.

[Brilliant]

Read your policy - the details! Ours has a clause that says services received from non-participating providers while in a network hospital will be paid at network rates. I'm not sure if it applies to ER visits; mine was a surgery. As soon as I called them on it, they adjusted immediately.

[justamouse]

Yeah, doncha love that one? We've had that happen a few times.

 

Don't pay it.

 

The hospital we go to is in network. When I go through the ER, I am NOT calling the ins company to ask if every person that touches me is in network. The hosp can work it out with the ins company. I refuse to pay those bills.

[Parrothead]

If the ER was in network, usually all you need to do is call and tell the insurance company. This has happened to us, and I said that it is impossible to ask each provider if they are in network. Once I had to write a letter stating that. Both times the bills were adjusted to in network rates.

:iagree: Contact the insurance company.

[tabrizia]

We've had to go through the appeal process before about this, every time we have won. We go to an in-network hospital, it is their job to make sure they send us people that take our insurance.

[ILiveInFlipFlops]

Thanks everyone. It turns out I read the coding on the bottom of the bill incorrectly. The actual problem is that because they billed me under my married name but our insurance still has me under my maiden name, these two claims were denied. All the rest of the bills went through fine though :confused: The woman at the insurance office couldn't explain it. She said I just need to tell them to resubmit with my maiden name on the bills. Whew! I hate fighting with insurance. I'm so glad I won't have to this time!

 

But I'll remember all your advice for next time. I've always feared ending up with some huge bill from an OON provider in a hospital scenario like this. I'll double check with our plan as well, so I can be sure.

 

Thanks!

[freesia]

We've had to go through the appeal process before about this, every time we have won. We go to an in-network hospital, it is their job to make sure they send us people that take our insurance.

:iagree: We fight it, too.

[Catherine]

The hospital and radiology were covered, but not the doctor. I did not appeal at the time (this was 9 years ago), but I'd encouraged you to do this. Hospitals probably allow this because if they are private institutions, they may choose not to compel their docs to sign onto the same insurance plans. So each is free to choose which plans to sign up for. It's the "you eat what you kill" business model, doncha know? But it's horrible for patients.

[lisamarie]

If the ER was in network, usually all you need to do is call and tell the insurance company. This has happened to us, and I said that it is impossible to ask each provider if they are in network. Once I had to write a letter stating that. Both times the bills were adjusted to in network rates.

 

:iagree: I have had to call my insurance company more than once about this. They've almost always ruled in my favor. Can you look up the specific dr yourself and see if they're in network? Or just call your insurance and say "Hey, this hospital is in network, so why aren't you covering me?"

[Crimson Wife]

We wound up having a bill sent to collections because our insurance claimed the doctor was in network so they paid the contract rate, but the doctor's billing people claimed that he wasn't under contract with the insurance so they billed us for the difference. We went round and round with both the insurance co. and the doctor's office and then later with the collection agency but unfortunately wound up having to pay to get it off our credit :cursing: