topic Re: What Do You Think in Community Chat

What Do You Think

Jordan2 — Sat, 25 Jul 2020 22:33:05 GMT

So I had cataract surgery on June 17 at a facility where all the eye surgeries are done for this large multi office eye centers. The doctor and surgery facility are both in network for my health insurance. The facility has my insurance information and knows what insurance I have. So guess what I got today, a bill from the anesthesiologist for $1,825! I don't know why I would get such a large bill. I will call my insurance company on Monday. Can they say the doctor was out of network? That shouldn't be my fault as the facility was aware of what insurance I had. Am I suppose to tell them, no I'll have the surgery without any anesthesia? I have heard this happening before, but I don't feel it is right. If I end up having to pay the whole thing, I'm going to pay it in many installments.

Re: What Do You Think

nana59 — Sat, 25 Jul 2020 22:37:57 GMT

@Jordan2 wrote:
So I had cataract surgery on June 17 at a facility where all the eye surgeries are done for this large multi office eye centers. The doctor and surgery facility are both in network for my health insurance. The facility has my insurance information and knows what insurance I have. So guess what I got today, a bill from the anesthesiologist for $1,825! I don't know why I would get such a large bill. I will call my insurance company on Monday. Can they say the doctor was out of network? That shouldn't be my fault as the facility was aware of what insurance I had. Am I suppose to tell them, no I'll have the surgery without any anesthesia? I have heard this happening before, but I don't feel it is right. If I end up having to pay the whole thing, I'm going to pay it in many installments.

i'd pay it with rolled coins......i can help you out with that...my grandkids have been rolling coins...something to ease their boredom......

Re: What Do You Think

Still Raining — Sat, 25 Jul 2020 22:37:36 GMT

For me all my radiology md bills do come later, but they first bill the insurance. Could that be the case?

Re: What Do You Think

SunSprite — Sat, 25 Jul 2020 22:41:33 GMT

@Jordan2 Does your statement show any insurance payment or contractual allowance? Or was $1825 the full charge amount?

Given the quick turn around time (30 days) it's probably more likely that they didn't file your insurance at all. You probably just need to call the number on your statement on Monday.

Re: What Do You Think

fthunt — Sat, 25 Jul 2020 22:45:10 GMT

Question - so you were put 'under'? Like: out of it?

Thankfully I've had so few surgeries I may not understand your details correctly.. When I had both eyes done - I was wide awake and listening to doc and assistants gibber-jabber. My eye(s) were 'frozen" but nothing more.

IF that's the way they do it now - guess the bill is legit so present it to your insurance company. They may pay all or part of it.

Re: What Do You Think

Texasmouse — Sat, 25 Jul 2020 22:52:08 GMT

@Jordan2 wrote:
So I had cataract surgery on June 17 at a facility where all the eye surgeries are done for this large multi office eye centers. The doctor and surgery facility are both in network for my health insurance. The facility has my insurance information and knows what insurance I have. So guess what I got today, a bill from the anesthesiologist for $1,825! I don't know why I would get such a large bill. I will call my insurance company on Monday. Can they say the doctor was out of network? That shouldn't be my fault as the facility was aware of what insurance I had. Am I suppose to tell them, no I'll have the surgery without any anesthesia? I have heard this happening before, but I don't feel it is right. If I end up having to pay the whole thing, I'm going to pay it in many installments.

@Jordan2 that happened to me when I had my cataract surgery as well as when I had surgery on my foot. I made sure the surgeon and the facility were in my network but on both occasions, I got billed for the anesthesiologist's services. When I called my insurance company (Aetna) I was told that anesthesiologists work like "freelance" and are usually not in network.

Re: What Do You Think

suzyQ3 — Sat, 25 Jul 2020 22:55:16 GMT

@Texasmouse wrote:
@Jordan2 wrote:
So I had cataract surgery on June 17 at a facility where all the eye surgeries are done for this large multi office eye centers. The doctor and surgery facility are both in network for my health insurance. The facility has my insurance information and knows what insurance I have. So guess what I got today, a bill from the anesthesiologist for $1,825! I don't know why I would get such a large bill. I will call my insurance company on Monday. Can they say the doctor was out of network? That shouldn't be my fault as the facility was aware of what insurance I had. Am I suppose to tell them, no I'll have the surgery without any anesthesia? I have heard this happening before, but I don't feel it is right. If I end up having to pay the whole thing, I'm going to pay it in many installments.

@Jordan2 that happened to me when I had my cataract surgery as well as when I had surgery on my foot. I made sure the surgeon and the facility were in my network but on both occasions, I got billed for the anesthesiologist's services. When I called my insurance company (Aetna) I was told that anesthesiologists work like "freelance" and are usually not in network.

@Texasmouse, this is a common practice. It's just of a million things wrong with our health system.

Re: What Do You Think

azgal — Sat, 25 Jul 2020 22:58:10 GMT

First I would call the Doctor's office to see if they billed the insurance.

If they did, then I would call your insurance company for an explanation.

I had this happen to me and filed a dispute with my insurance company and they paid the bill.

Good luck. I hope it turns out to just be a mistake.

Re: What Do You Think

Texasmouse — Sat, 25 Jul 2020 23:01:25 GMT

@suzyQ3 there had been talk of implementing legislature to prevent "surprise" medical billing but I never heard whether or not it was ever passed.

There should be transparency on these types of extra costs, discussed during the planning stages of a procedure. It's not right to hit someone with a bill they never expected and didn't budget for, after the fact.

Re: What Do You Think

SunSprite — Sat, 25 Jul 2020 23:05:08 GMT

@Jordan2 Also, if they filed it to your insurance carrier you should have received an explanation of benefits; even if your carrier did not pay or denied it. The patient usually receives the eob before the provider recieves their payment.

Did you receive anything in the mail from your insurance yet for this charge?

Re: What Do You Think

azgal — Sat, 25 Jul 2020 23:06:46 GMT

@Texasmouse Some states don't allow it. I also heard the Feds were trying to make that a national law but I don't know what happened to that.

Re: What Do You Think

CLHS68 — Sat, 25 Jul 2020 23:08:50 GMT

I don't know if this is what happened to you. My doctor warned me that a lot of anesthesiologidts & ER workers will not accept any insurance. His daughter also got a big bill because of this.

Re: What Do You Think

Cakers3 — Sat, 25 Jul 2020 23:13:24 GMT

@Texasmouse wrote:
@suzyQ3 there had been talk of implementing legislature to prevent "surprise" medical billing but I never heard whether or not it was ever passed.

There should be transparency on these types of extra costs, discussed during the planning stages of a procedure. It's not right to hit someone with a bill they never expected and didn't budget for, after the fact.

@Texasmouse I agree that many anesthesiologists are freelance but patients are given a form to sign indicating they will be responsible for any charges not covered by insurance.

This is the tricky part-always call your insurance provider FIRST and if you have a "live chat" or other messaging system, ask ALL questions so that it is in writing.

Then you have to call your doctor/clinic/etc. and go over ALL details of coverage.

"In-Network" doesn't always mean 100% paid, either.

My anesthesiologist was freelance but insurance picked up all but $100 because of her contract with the doctor and location.

It all depends who, what, where, etc. Unfortunately every case is different so we have to do our own footwork to make sure everything is in order.

Re: What Do You Think

lovesrecess — Sat, 25 Jul 2020 23:14:57 GMT

DH has had almost the same thing happen. He had a colonoscopy done at an in- network clinic in early March that verified his insurance, etc. He was told he only owed his copay and would be billed for it. He got a bill for $14k for the anesthesiologist! DH called insurance co. and they said the clinic is in-network, the anesthesiologist is not. He is contract, so not on any network. Called billing and they said they would “ get back to us”.

Re: What Do You Think

lovesrecess — Sat, 25 Jul 2020 23:21:06 GMT

They should tell you ahead of time if anyone is going to be a contract, no- network doctor. I don’t think drs have the option of not accepting insurance payment. Money is money, but insurance contracts mean the drs agree to take less. If they can bill the patient directly, they can insist on the whole amount, or as much as they want to charge, I guess. It’s a racket!

Re: What Do You Think

ScrapHappy — Sat, 25 Jul 2020 23:24:21 GMT

@Jordan2 wrote:
So I had cataract surgery on June 17 at a facility where all the eye surgeries are done for this large multi office eye centers. The doctor and surgery facility are both in network for my health insurance. The facility has my insurance information and knows what insurance I have. So guess what I got today, a bill from the anesthesiologist for $1,825! I don't know why I would get such a large bill. I will call my insurance company on Monday. Can they say the doctor was out of network? That shouldn't be my fault as the facility was aware of what insurance I had. Am I suppose to tell them, no I'll have the surgery without any anesthesia? I have heard this happening before, but I don't feel it is right. If I end up having to pay the whole thing, I'm going to pay it in many installments.

Many times the anesthesiologist is not employed directly where they are practicing but rather "contracted out." Can't think of another way to say it. Happens all the time in the hospitals. Just because you're covered by going to an in-network hospital, doesn't mean the doctors are in network. But, who thinks of asking that question during a time like that? I've seen stories about this on the news many times, especially in emergency situations such as going to the ER for a heart attack or something urgent. You go to your hospital that you know is in network then get slammed with doctor's bills because they're not in network. There were many people wanting a bill or something passed that if a doctor works at a hospital, any hospital or facility, then they should be in network.

Re: What Do You Think

DAD — Sat, 25 Jul 2020 23:25:57 GMT

Do not pay it right away. I would make sure the Dr.'s office has billed it correctly. It has happened to my parents many times.

Re: What Do You Think

Cakers3 — Sat, 25 Jul 2020 23:34:09 GMT

@DAD wrote:
Do not pay it right away. I would make sure the Dr.'s office has billed it correctly. It has happened to my parents many times.

@DAD That is another important point.

Medical billing can be a nightmare.

Re: What Do You Think

Annabellethecat66 — Sun, 26 Jul 2020 00:00:52 GMT

I was supposed to get it done at the end of last year.

The person who gives you the relaxing stuff (forget what it's called) made a big deal out of the fact that I see a cardiologist.

My cardiologist sent them a fax saying I was cleared to get the surgery. Then they wanted a new EKG even though the one I'd had done was just a few months old, so I got another one. Then they wanted something else, I complied with their wishes.

My cardiologist was so angry smoke was coming out of his ears. He said you've had every test done and passed it. He said, "I'm a cardiologist. I operate on people's hearts and we don't require some of what this anestheoligist wants. It's just a mild sedative to relax you.

They finally called and said they didn't feel right doing it at this time. My Dr said, "Find someone new. I'll give you the name of the person whom my father used."

He did. But then the virus came and the rest is history.

I hope it's settled for you and you don't owe any money. It's terrible when a large bill comes to someone.

If you do have to pay it, send them a few dollars every month. As long as you are paying it, they can't do anything to you.

Take care and please let us know how you are doing. Annabellethecat

Re: What Do You Think

SunSprite — Sun, 26 Jul 2020 00:04:46 GMT

@Annabellethecat66 wrote:

If you do have to pay it, send them a few dollars every month. As long as you are paying it, they can't do anything to you.

You are allowed to send any account to a collection agency, if it's not paid in full OR if there is not an agreed upon payment arrangement made with both parties in agreement.

All states are not the same, but many do share that general rule.

I suggest you check into that carefully.