The anesthesiologist was NOT In-Network!!!

Some good suggestions for negotiating this nonsense.http://www.nytimes.com/2013/10/19/your-money/out-of-network-not-by-choice-and-facing-huge-health-bills.html

I would also have a good talking-to with my surgeon - he's the one who got you into this mess.

I just got a hospital bill for > $27,000!  My insurance showed that they pai nothing!  This hospital is in my network, I've used it before.  Called my insurance company and the person looked into and said that the hospital used billing codes that hadn't been used in years.  I have 2 questions:

1) since the insurance company knew the codes hadn't been used in years wouldn't you think they would contact the hospital directly since it is in-network?

2) I thought you had to go to school to learn medical billing and then be trained on the particular program used at the billing facility.

I'm waiting for my insurance company to call me back today after they talk to the hospital.  This bill is for my bilateral mastectomy w/ tissue expanders and for a surgery to remove one expander due to an infection.

The hospital can resubmit the bill with the proper codes & that might take care of it. It did in my case.

As for the anesthesiologist, grrrrrrrrrrrrrrrrrr. They are notorious for not contracting with insurance companies. There are no in network anesthesiologists where I live. I have BCBS. When I called BCBS, I was told that in order to become a "preferred provider" all the doctor has to do is agree to their terms/reimbursement. BCBS paid about $400 of my $2,000 anesthesiologist bill even though he was out of network. You usually can't pick your anesthesiologist(in my case there wasn't one to be found). I called the billing office asking for my bill to be reduced. I was told that 1st I had to write to BCBS & ask for reconsideration. BCBS wrote me a much better letter back saying they weren't going to pay anymore because what they paid was reasonable for my region. I sent this letter to the billing people & my bill was finally reduced to about $600-700(with my insurance paying $400). $200-300 out of pocket for me.

During one of my phone calls I did go off on the billing person at the anesthesiologist office. I tried to play the cancer card...........dealing with cancer & now this...........My writing the insurance company was really just getting the patient to fight the anesthesiologist's battle. That is what I resent.

Mellie, sorry you have to put up with this insurance bulls***!    I hope your treatments are going well

This really irritates me- The hospital, surgeon and anesthesiologist all have an obligation to make sure you are authorized by your insurance for the services they are providing. They should also be informing you in writing if something is not "in network" and you are responsible for the bill.  I would call the hospital billing office and say you are disputing the anesthesia professional bill- say you would like to know how anesthesia providers are assigned to surgical cases and how many are available on weekends and how they make sure there is authorization for services BEFORE the patient has surgery. 

They will give you a big bunch of lip service but then I would call your anesthesia and surgeon billing offices and ask them the very same questions and tell them you are disputing the bill because you were not informed that the anesthesia provider assigned to your case was out of network for your health insurance.  

Here is your secret weapon- if I am reading this correctly you had surgery on a weekend?Probably no one did any kind of pre-authorization because it was not planned.  Typically there are very few anesthesia providers on call on the weekend in some places only one MD for surgery and labor and delivery-you did not have elective surgery on a weekend so that provider should accept what your insurance pays or should not be providing call services on a weekend.  

I will keep watching this thread to see how you  make out. 

Here's another way to handle an insurance complaint... Complain to your state insurance department.  Before writing to the state insurance department, I would tell the insurance company that you are planning to write to the insurance department.  That might make them more agreeable....

https://eapps.naic.org/cis/fileComplaintMap.do

I handled my appeal over the phone. I called member services. I had also signed the paperwork regarding out-of-network responsibility. The woman I spoke with sent in my appeal for me. I had an option to send something in writing, but received the check from the insurance to pay the anesthesiologist. Do you have a case manager through BC/BS? I received a call from one, not sure how they choose who gets one.

this is probably too late, too little, but I am a coder and used to code for anesthesiologists.  they do not have to be in network, they  are considered to be covered under the RAPS provision.

RAPS= radiologists, anesthesiologists, pathologists.

they are all considered in network because you have no control over who any of these people will be.

I had a similar issue occur and appealed to bc bs.  They corrected the anesthesia payment directly while on the phone with them . Didnt even need to put it in writing. Good luck. Make your calls keep track of names and dates and then put everything in writing.