Doctor Was Out-of-network ...

Jun 23, 2016

  1. kingbrand
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    kingbrand New Member

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    Hi all. Hopefully this is the right section to post this question in.

    I had surgery not too long ago. Then today I received paperwork from my insurance company indicating that the anesthesiologist is out-of-network -- i.e. he will expect me to pay for a portion of his bill bc the insurance company is only paying part of it.

    So can anyone tell me, what kind of repercussions can I expect if I do not pay? (Bill collectors and damage to my credit rating?)

    Thanks in advance.
     
  2. goillini52
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    goillini52 MAGA...Eat More Bacon & BUILD THAT WALL!!!

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    The next time you have surgery, they won't use anesthesia.:no:
     
  3. somarco
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    somarco GA Medicare Expert

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    You have participated in a PARE claim.

    Pathology
    Anesthesiology
    Radiology
    Emergency

    Quite common for gas passers to be a non-par provider.

    As for refusing to pay the balance due, the doc will probably turn you over to collections at some point and ding your credit.

    Just curious. Do you often receive services and refuse to pay? Assuming you have a job, how often do you work for your employer and not get paid?
     
    somarco, Jun 24, 2016
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  4. goillini52
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    goillini52 MAGA...Eat More Bacon & BUILD THAT WALL!!!

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    "Gas passers"...:twitchy:.....I do a fair amount of gas passing myself.:laugh:
     
  5. somarco
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    somarco GA Medicare Expert

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    And Monkey Man is also out of network.
     
    somarco, Jun 24, 2016
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  6. kingbrand
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    kingbrand New Member

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    Hi again. I see that there have been some responses already, so let me address those. First I want to thank everyone who has expressed well wishes for my predicament, either on-forum or privately. To anyone who feels offended by the questions in the last paragraph, I am sorry.

    Concerning the surgery I had already – barring any significant changes in my life – I believe my only option may be to pay with a credit card and hope to get out of debt in the future.

    However, I believe it is possible to avoid this same outcome next time (I already know that I will need another surgery). I have now learned that that particular hospital has no anesthesiologists who are in-network for my insurance … but I have also learned that my surgeon works at another hospital, and that hospital does have an anesthesiologist who is in-network for my insurance.

    I expect I'm going to do significantly more research (I figure a few hours, or even dozens of hours, work is insignificant compared with being charged thousands), but at least I believe said research is moving in the right direction. But can anyone here tell me: beside an anesthesiologist, are there other specifics that I should research? It seems that the best thing to do would be to tell the hospital that I want a list of everyone who will be involved in the surgery (so I can check them with my insurance company.

    Again, thanks to everyone who has or will participate on this thread,
    kingbrand

    ----------

    To your question, somarco, I think the best answer is that I generally don't request services if I am incapable of paying for them.
     
  7. FLM2
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    FLM2 Guru

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    This happens all the time with anesthesiologists, unfortunately, and the hospital or surgical center should advise in advance of this issue but almost never do.

    My clients have had some success with calling their insurance company and explaining what happened, that you weren't advised, that the hospital/surgical center and surgeon were all in network, and this charge isn't fair. You should also call the anesthesiologists' office and say exactly the same thing.

    If you do this, it's possible that the insurance company may move the charge to in network and negotiate fair payment to the anesthesiologist or the doctor may agree to accept the network negotiated rate.

    If neither of the above happens you are stuck paying the bill, unfortunately, but it's definitely worth the effort.
     
    FLM2, Jun 24, 2016
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  8. kingbrand
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    kingbrand New Member

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    Thank you very much. I've started writing a letter to the insurance company, which I'll post below. (Just a rough draft and this point; and I've removed specifics from it, naturally.)


    Dear ________,

    I had surgery at ________ Hospital not too long ago. I learned afterward that, although the hospital and the surgeon are in-network, the anesthesiologist is out-of-network.

    I would like to ask:

    First, are there steps I can take before my next surgery to prevent the same issue occurring? (I looked on your website but it does not show any in-network anesthesiologists affiliated with ________ Hospital.)

    Second, is there anything that can be done about the existing bill of services?
    (I have been told that sometimes an insurance company will move such a charge to in-network and negotiate payment.)

    Background: These surgeries are to cure me of ________, which I was diagnosed with some years ago. This will also mean that I will no longer need ________ treatments ...

    ----

    Although I don't say this explicitly, the treatments I have already been on are extremely expensive – mentioning them in the letter may remind the company that the surgeries actually benefit them financially, and hopefully that will help my cause.
     
  9. somarco
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    somarco GA Medicare Expert

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    Had you known your full out of pocket exposure in advance, would you still have had the surgery? Or would you still want to stiff the provider?

    There is a reason why providers are non-par. They won't negotiate with carriers.

    The carrier has no incentive to negotiate on your behalf. But if it makes you feel better, go for it.
     
    somarco, Jun 26, 2016
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  10. FLM2
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    You can draft all of the letters you like, none of them will work unless you call them and try to convince someone to help you.

    I've given you the template for success (it's worked several times for my clients but not a guarantee by any means), good luck with whatever you choose to do.
     
    FLM2, Jun 26, 2016
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