I had my surgery back in Aug 07. I had ACDF surgery. I received a bill about a month ago for the anesthesia portion that was 3200 dollars. I called the number on the bill and she contacted my insurance company and they reprocesses the claim and paid I believe 1200. First of all, I was never told that the anesthesilogist performing the procedure with my surgeon was out of network. My surgeon was in networka and so was the hospital. It wasnt my choice who the surgeon chose to do the anesthesia. Who is responsible for this? Please advise. THey are billing me 1900 dollars. Thanks
I can see a 20-30% gap between negotiated (or reasonable & customary) and what the non-network provider is billing you, but don't understand how your Carrier deems $1200 reasonable, usual & customary for a $3200 service. Either your anesthesiologist is out of line with their expectation, or your Insurance Carrier has set some unrealistic guidelines. You need to contact your Insurance Carrier and ask them if there are any in-network anesthesiologists, in the hospital where you had your surgery & if there are, would they have done the same work for $1200. Once you have that info, we can plan the next steps.
Anesthesiologists are almost always conveniently out of network--convenient for them, anyway, because then they can jack their prices up as out of network reimbursement is usually far better than a PPO/HMO contracted one. And you're left holding the bag on the reasonable and customary balance. You can try to appeal the R&C cut with your insurance company, I agree $1200 seems a little low but $3200 also seems a little high. How much did your surgeon charge?
Call your surgeon up and ask him why he's purposely breaking the terms of his contract with your PPO as virtually all PPO contracts have a clause which states they're supposed to direct your care to another in-network physician. Of course, some of them never do, and then you're left with a $1900 bill like now, and then the surgeon and hospital will try to pin the blame on your insurance company and make them out to be the bad guys.
The patient always gets caught in the middle. Always.
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