In network Anesthesiologist, out of network billing scheme?

Question

I had a simple surgery on April, now is reviewing the doctors' bill, I had a bill from this Anesthesiologist want to charge me 500% of RBRVS rate $900 for the service directly and mentioned that I had to pay the full amount, my health insurance is PPO, it sent me EOB explaining that this anesthesiologist is an Out of network service provider, so the insurance company just paid $66, I pay $66 plus the bill balancing of $768. I checked this Anesthesiologist's name is in the insurance company data base, her billing office denied that she is an in network, I noticed that she is using another medical group out of state to bill the insurance company...
I called the insurance com. customer support, and get them reprocess the out of network bill into In work bill since I can point out the Physician ID and they reply with her name and address in the data base, what should I do to this Anesthesiologist's bill, pay the PPO rate and ignore her bill and send her the proof that she is in netwok..

Answer 1

Contact your insurance provider and ask that the bill be re-processed as an "invisible provider" or "hidden provider".

You don't get a choice of anesthesiologists, and we don't get to choose our patients.

Add that to the fact that insurance companies routinely screw up our claims, and you end up with a mess. They should pay as in-network.

Good luck.

Answer 2

Sad to say, it's your responsibility to insure that any service providers you use are within your network. If she was not a network provider, you are stuck with what you have been offered.

The fact that this anesthesiologist is in the insurance company's database does NOT mean that she is within network. To determine that, you need to check the list of approved providers for YOUR particular network plan.

Whenever you are involved with a PPO, it is always wise to check ahead of time to make sure that all services you are about to receive are covered under the PPO agreement.

Answer 3

Now, depending on your insurance carrier and the hospital where the procedure took place,,,,,,There is a thing called a "hidden provider rule", meaning that if you used an "in network" provider and were at an "in network" hospital then your insurance should pay it. You had no choice in what anesthesiologist that was used.

Contact you health insurance carrier and question this rule with them.

Answer 4

not sure precisely what coverage business company you have, yet frequently that's what they call the 'ologist rule'. You flow to an in-community wellness midsection or usual practitioner and that they make the main of somebody else to do particular issues, which isn't on your administration (anesthesia, labs, x-rays to call some). frequently you call the coverage business company and that they modify the declare to pay in-community as long as they are in a position to work out which you went to a shriveled facility/place of work. possibly you have a self funded company (meaning they write their own contracts) that EXCLUDES making use of the 'ologist rule'. in case you have tried the coverage business company, I do propose soliciting for a supervisor. You pronounced the standard practitioner place of work is doing the allure, make confident they are in a position to allure it for you. i be responsive to in my state (IL) an out of community service has to have WRITTEN authorization from the member to do the allure, so we deny them.

Answer 5

pay the bill.if you ignore it you are going to end up paying more in the long run.it could also mess with your credit score.