Anesthesiology and insurance network

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MeToo14
MeToo14 Member Posts: 493
edited December 2014 in Surgery - Before, During, and After
Anesthesiology and insurance network
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  • MeToo14
    MeToo14 Member Posts: 493
    edited December 2014

    I wanted to see if anyone else has had this problem. I had a lumpectomy 3 weeks ago and the surgical center I went to was in my insurance network. However, I now have gotten a bill from my anesthesiologist and have been told I am responsible for the entire amount because he was not in my network. I didn't realize that he was contracted through the center and I feel totally lied to. I have to have a second surgery and have found out that the anesthesiologist is not in my network. I don't have a choice this is the only place the hospital contracts with and I am going to be stuck with this bill. I reached my out of pocket maximum a long time ago. Is there anything I can do? My insurance company has basically hung me out to dry on this. Has anyone else run into this problem?

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  • coraleliz
    coraleliz Member Posts: 1,523
    edited December 2014

    Similar. None of the anesthesiologist in my area contract with my insurance.My insurance agreed to pay some. If I remember correctly about $600 of a $2,000 bill. The anesthesiologist around here charge about $1,000 per hour. It took letter writing & phone calling which is the last thing you want to be doing when diagnosed with cancer. I went off on the person on the other end of the phone a couple of times. I doubt this helped. After I got my insurance to pay $600, I contacted the anesthesiologist billing dept & they told me to appeal my insurance company to pay more. I had to do this in writing & submit a copy of their denial of additional payment. The anesthesiologist billing dept finally agreed to accept 50% of the original bill(600 from insurance & 400 from my pocket).

    When my husband had surgery more recently, I just called the anesthesiolgist billing dept & they discounted it over the phone. Same players, just much easier! Good luck. At the very least, you should be able to get the bill discounted.

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  • justachapter
    justachapter Member Posts: 158
    edited December 2014

    I work in benefits. A few things, if you can't get anywhere with the insurance company appeal it. Appeal it on the grounds you went to an INN facility and you didn't have a choice with the anesthesiologist. Second, if you met your OOP max, you shouldn't owe any money, everything should be covered at 100% for the remainder of the year, if your benefits are on a calendar year. Unless, there is a different OOP Max for INN vs OON?

    Do not pay the full bill, you should not have to, if you went INN. Usually most insurance companies will pay at INN level or won't and then it eventually is reprocessed as INN, if you only have INN and did everything in your power to do what you were supposed to do.

    Good Luck!


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  • justaveragejane
    justaveragejane Member Posts: 10
    edited December 2014

    I agree with the previous post. I actually work for an anesthesia group and this is a very common scenario. The anesthesiologist normally will appeal several times including asking to be paid under the R(adiology) A(nesthesia) P(athology) policy many insurance companies use for this type of out of network providers. Some insurance companies, like Humana, require the patient to appeal rather than the provider. Make sure you call the anesthesiologist billing dept they will let you know if you need to appeal also. Frequently the insurance will pay the patient directly rather than the provider after a patient appeal. Unfortunately most ins policies have separate out of network and in network deductibles and out of pocket limits.

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  • jbdayton
    jbdayton Member Posts: 700
    edited December 2014

    This is becoming a common problem. I had an emergency gallbladder surgery in August at an in network hospital. The anesthesiologist was out of network. I received his bill with a note to send it to my insurance company stating it was not fair to have to charge the patient the difference since they could not choose the anesthesiologist. I do not know if it has been resolved yet. I am letting them fight it out first.

    Tomorrow I am having a carpal tunnel surgery and I was told to call the anesthesiologist (I was actually given his cell phone, the doctor himself answered and talked to me). I asked if my insurance is in network. Of course, he isn't. He said he would work with insurance and I would probably have to talk to insurance as well, to get the bill paid. He said they have to do this all the time because they are doing services at the hospital and the hospital is in my network and my surgeon is in network.

    Insurance is being greedy with what they are paying them. Sounds like the anesthesiologists are banding together and none are joining the networks. I see a power struggle starting. Hopefully, this will resolve itself without many patients taking the hit. I hate paying big premiums and then having to fight for payment of doctors for their services.

    Good luck getting your bills covered. Be persistent it may take awhile.


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  • MeToo14
    MeToo14 Member Posts: 493
    edited December 2014

    Thank you everyone for your advice! From what I now understand this is just the way it is, it's very frustrating! I am currently trying to work this out and hopefully will be able to negotiate a lower price. To add to this I have to have an additional margins surgery next week, and of course, the anesthesiologist is not in my network. As if have a life threatening disease isn't enough, this is truly adding insult to injury. Happy holidays girls!!!!!

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  • Kicks
    Kicks Member Posts: 4,131
    edited December 2014

    I haven't had to deal with Insurance companies and the more I hear about them the happier I am that I don't. My care is through VA so they arrange the appt, send approval, I walk in to the appt and walk out. Because I have no SCD, I do have a co-pay but it is minimal. Hubby does have some SCDs so his care related to those issues has no co-pay but on some other 'things' he has a co-pay. All of my IBC care was outsourced/voucherd to a local private surgeon, Chemo and Rads were outsourced/vouchered to the local Cancer Care Center. When my rt retina detached, I was sent to the local Eye Institute (that was not a good place though quite large and supposedly 'good' - wrong) but I was gotten into a fantastic eye specialist the next day. His office has a voucher good until next June for my eye care and will be extended.

    I do have to say that for me (and Hubby), could not ask for better or more prompt care through VA - be it at VA Facilities or immediately outsourced/referred when the needed care was not available at the local Facility.

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