Jann in TX Posted January 17, 2013 Share Posted January 17, 2013 Did you know that if you go to an ER that is IN your insurance network you are supposed to ask the Dr if he/she is in network before services are rendered or you are liable (supposedly) for the out of network bill (at full price without reductions) for the Dr's services!!!!! Crazy. I've been on the phone all afternoon trying to sort out a claim from last October when my middle daughter cut the top of a finger off while home visiting from college!!! Our insurance shows the claim paid in full-- but the Dr has sent his bill to collections... (you know what that means-- letters and calls EVERY SINGLE DAY... ugggg We had considered an Urgent Care fascility that was across from the ER... we called them first and they were afraid that she would need a plastic surgeon so instructed us to go to ER first... A regular ER doc stitched her up... After several hours on the phone I just may have found someone who will take care of this for me... but they say we will still have to pay extra--but it should be under $50... Now I'm going to fight the smaller charge (but I'll pay it first so it does not damage my credit rating). Quote Link to comment Share on other sites More sharing options...
melmichigan Posted January 17, 2013 Share Posted January 17, 2013 I'm not sure I buy that if the hospital is IN network. What does the insurance say? If they say the claim is paid then I would report it to them, the hospital and staff should have to accept the charges. Quote Link to comment Share on other sites More sharing options...
Tammyla Posted January 17, 2013 Share Posted January 17, 2013 :confused1:. Our medical insurance system is getting crazier and more and more outrageous. Quote Link to comment Share on other sites More sharing options...
Random Posted January 17, 2013 Share Posted January 17, 2013 I knew that. It happened to my sister, who took her daughter to a in-network ER, only to be billed outrageously by one of the docs her daughter saw. Keep up the fight. I hope you win. Quote Link to comment Share on other sites More sharing options...
TexasRachel Posted January 17, 2013 Share Posted January 17, 2013 Yup. This is standard practice. It has been for years. Doctors are different than the hospital. In my experience no anesthesiologist is ever in network. Same with ambulances. But then when you need one, you're not really in a position to argue. Quote Link to comment Share on other sites More sharing options...
MindyD Posted January 17, 2013 Share Posted January 17, 2013 If the hospital is in the network, you shouldn't have to pay extra. I had a situation when I had my dd kind of similar. I went into labor, and the on-call doctor for my doctor was the one to deliver. At the time he was at a different office, and a few weeks later I started getting bills for the doctor that delivered me. It took me more than one phone call to get my doctor's office to get their doctor's office to stop billing me. Keep going up the chain until you find someone that will listen. Maybe your insurance will take over for you and talk to them? Quote Link to comment Share on other sites More sharing options...
Amy in NH Posted January 17, 2013 Share Posted January 17, 2013 And if your IN network doctor's office draws your blood IN the office, or gives you a pap exam, you must check to make sure they send it to an in network lab? Quote Link to comment Share on other sites More sharing options...
BakersDozen Posted January 17, 2013 Share Posted January 17, 2013 I experienced this when my babies were in the NICU. An out-of-network physician saw them twice (at $941 for about 5 minutes in the room...but that's another gripe/post) and I was charged the full amount as my insurance would not pay. After consulting the ladies here I began the fight...and won! Charges were written off by the physician's group as I made my case very well (along with informing them that they would hear from my lawyer; I don't have a lawyer, but it sounded good, lol). What I stated in my letter was that their practice was no different than if I went to McDonald's and ordered a hamburger yet was served a burger from the place across the street. Checking network status is a ridiculous thing to expect patients to do, especially in an emergency situation and even more especially when you are in an in-network hospital/facility. Quote Link to comment Share on other sites More sharing options...
QueenCat Posted January 17, 2013 Share Posted January 17, 2013 Checking network status is a ridiculous thing to expect patients to do, especially in an emergency situation and even more especially when you are in an in-network hospital/facility. :iagree: My sister went through a similar situation when she gave birth. I know it got resolved in her favor but don't remember exactly how (it was a long time ago). Quote Link to comment Share on other sites More sharing options...
LucyStoner Posted January 18, 2013 Share Posted January 18, 2013 This sort of stuff is what makes our healthcare system so inefficient. Quote Link to comment Share on other sites More sharing options...
Jennifer3141 Posted January 18, 2013 Share Posted January 18, 2013 I did know this! My husband is a physican not employed by the hospital, which means we set our individual contracts with every single insurance company. And there are some out there who try to get away with paying well, dirt. So what we do with patients whose insurance we do not accept is that DH explains why to every patient and then I have a typed out letter explaining why with the contact information to me AND their insurance company. We do this so a drugged out patient will have something to physically show different family members as they come into the patient's room. And also because different people assimilate information differently. I am a reader. I need to see things in writing so I understand them fully. I assume other people are the same way. About 98% of the time, people pay out of pocket for my DH and then submt for reimbursement. But there are people who cannot afford to do that and we do not want some patient fighting for his or her life, only to get out of the hospital and discover crazy bills that aren't covered. It annoys me that other medical providers don't do the same. Yes, it takes more time. And yes, patients deserve to know what they will be facing after the medical crisis is over. And frankly, I deserve the right not to go to battle over my DH's pay with every patient. Argh to that one too. Quote Link to comment Share on other sites More sharing options...
J-rap Posted January 18, 2013 Share Posted January 18, 2013 That is crazy! I would definitely keep fighting it. What a hassle that it's up to YOU to straighten it all out. I can imagine that happening in our local hospital. We live in a small town, and on weekends, ER doctors rotate in from other parts of the state. It is our hospital's decision to do it that way; it seems they should be responsible for paying the difference in rates, if there is any. Quote Link to comment Share on other sites More sharing options...
JFSinIL Posted January 18, 2013 Share Posted January 18, 2013 Hubby handles insurance stuff all the time as part of his job (he is an attorney) and this has cropped up more than once. May depend on State law - here, he has successfully for clients AND US (yup - we've had this happen, too) gotten the bills reduced - if a person uses a hospital IN NETWORK they are allowed to trust that all the folks treating them in the IN NETWORK hospital will be also IN NETWORK! If they are not - that is the doctor or whomever's problem. We pay the in-network amount. We have done our job by choosing to go to the IN NETWORK hospital in the first place. Quote Link to comment Share on other sites More sharing options...
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