How is this even legal??

[vic120]

I had an issue, my older had some stomach issues his primary referred to nationwide hosp for specialist

Now not only was there a long waiting piriod, Which I was told there are no other Children's GIs available, so just had to deal with it

Then Nationwide called 2 times to verify information including insurance information,

Then when I got there I had 2 doctors to see there and had to verify insurance 2 times for each doctor, and in fact they knew what insurance I had they told me what I had

Then I am getting bill for both doctors visits and all the tests for $2000

I say wait I already paid my deductible,

and they say oh we are not in your insurance plan

I say why did you not tell me this and they say we don't want to discriminate some people don't have insurance and we don't want to deny care

I say woo no one said anything about deny care, but to make a informed decision i don't have $2000 I would not have made this choice, when I already paid 30 K between ins and deductible and coinsurance

but they double down on the not discriminating thing and say I could apply for financial assistance which I will not qualify for

No matter what they will not budge, the refurring doctor will not take responsibility and insurance company will not do anything
except after over a month fight with them they finally found another GI in network in the next state over

and after months worth of fighting they only thing they will give me is 10% off, I am willing to pay half, I mean after paying soo much for medical every year and all I have to pay extra for my youngest who is autistic there is just not money for medical that I would not knowingly go out of network for

I had so much unexcepted happen this year, But I can deal with it when the plumbing has a 2K issue I was not expecting but this is crazy to me they have a right to do this

in what other buis can someone treat people like this, and not be open on what is covered or not?


could you imagine, you have car trouble and the shop you tell them I have alll these points on your visa and you want to use that
and they say ok that is good and do the work and then hand you a bill for $1000 and say they do not take CC's

 

[LeeV]

Sorry for your troubles, hope all gets better for you. A couple of things came to mind as I read your post.

Is Nationwide a carrier or hospital? I do not know of a hospital named Nationwide, so I am assuming it is the carrier.

The responsibility for verifying provider in or out of network is yours, no one else. Sorry.

Hate to say this, but unless there is more to the story than is here, the providers appear to be doing what they are supposed to do.

 

[vic120]

Sorry for your troubles, hope all gets better for you. A couple of things came to mind as I read your post.

Is Nationwide a carrier or hospital? I do not know of a hospital named Nationwide, so I am assuming it is the carrier.

The responsibility for verifying provider in or out of network is yours, no one else. Sorry.

Hate to say this, but unless there is more to the story than is here, the providers appear to be doing what they are supposed to do.

Nationwide children's hospital in Columbus

 

[vic120]

Sorry for your troubles, hope all gets better for you. A couple of things came to mind as I read your post.

Is Nationwide a carrier or hospital? I do not know of a hospital named Nationwide, so I am assuming it is the carrier.

The responsibility for verifying provider in or out of network is yours, no one else. Sorry.

Hate to say this, but unless there is more to the story than is here, the providers appear to be doing what they are supposed to do.

Besides that they took and confrmed my insurcane info no less then 7 times

I mean what other industry would anyone get away with this??

I am sorry I dont get it

Also I have never had a client ever have such an issue, In all the rear's a sealing insurance never heard of such a thing

I have had people who provider would not let them set appointment till insurance showed in the system

I mean confirming my insurance 7 times seems to me just like confirming it is in network

I mean who does this

 

[Joseph Schneier]

I don't think this is legal with the No Surprise Bill. You must receive notice and consent to being balance billed for an out of network provider. If you did not sign a consent you should be billed at an in-network rate. This needs to be deliberated between your carrier and the hospital.


If you get health coverage through your employer, a Health Insurance Marketplace®,[1] or an individual health insurance plan you purchase directly from an insurance company, these new rules will:

• Ban out-of-network cost-sharing (like out-of-network coinsurance or copayments) for most emergency and some non-emergency services. You can’t be charged more than in-network cost-sharing for these services.
• Ban out-of-network charges and balance bills for certain additional services (like anesthesiology or radiology) furnished by out-of-network providers as part of a patient’s visit to an in-network facility.
• Require that health care providers and facilities give you an easy-to-understand notice explaining the applicable billing protections, who to contact if you have concerns that a provider or facility has violated the protections, and that patient consent is required to waive billing protections (i.e., you must receive notice of and consent to being balance billed by an out-of-network provider).

No Surprises: Understand your rights against surprise medical bills | CMS

The No Surprises Act protects people covered under group and individual health plans from receiving surprise medical bills when they receive most emergency services, non-emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance...

www.cms.gov

 

[Victor Crain]

Vic, The above answers are a little off-target. Who is the insurer? Individual plan or company insurance?
(1) Under the No Surprises Act, providers (doctors and hospitals) are supposed to advise you of your out-of-pocket liability before they do anything. You should ask about that if they don't volunteer the information.
(2) All medical bills are negotiable. You can do it directly or contract with a firm like Billing Angel to do it. (I have contacts there but I don't accept compensation for referrals. I only refer companies that I have a reason to respect.) A typical discount is 30% off list and you can then spread payments over time. Providers don't get much if they send someone to collections so they had rather negotiate.
(3) For emergency care, insurers will cover out-of-network providers as in-network. Further if there is no one with the specialty that you need in-network, you can get that approved as well.
Finally, I'm a veteran broker licensed and active in 14 states, including Ohio. If you want to call me, I'll help you get this sorted.
Vic Crain

 

[vic120]

Vic, The above answers are a little off-target. Who is the insurer? Individual plan or company insurance?
(1) Under the No Surprises Act, providers (doctors and hospitals) are supposed to advise you of your out-of-pocket liability before they do anything. You should ask about that if they don't volunteer the information.
(2) All medical bills are negotiable. You can do it directly or contract with a firm like Billing Angel to do it. (I have contacts there but I don't accept compensation for referrals. I only refer companies that I have a reason to respect.) A typical discount is 30% off list and you can then spread payments over time. Providers don't get much if they send someone to collections so they had rather negotiate.
(3) For emergency care, insurers will cover out-of-network providers as in-network. Further if there is no one with the specialty that you need in-network, you can get that approved as well.
Finally, I'm a veteran broker licensed and active in 14 states, including Ohio. If you want to call me, I'll help you get this sorted.
Vic Crain

Its Molina healthcare with the Marketplace

 

[vic120]

Ok I am trying to understand this, clearly there is protection for emergency situations, and for extra services sent out

My case is it was NOT an emergency situation, and they took all my info , But never informed me that it was out of network or there would be out of pocket because it was out of network

Not really sure I see that adressed in this law

 

[LeeV]

I don't think this is legal with the No Surprise Bill. You must receive notice and consent to being balance billed for an out of network provider. If you did not sign a consent you should be billed at an in-network rate. This needs to be deliberated between your carrier and the hospital.


If you get health coverage through your employer, a Health Insurance Marketplace®,[1] or an individual health insurance plan you purchase directly from an insurance company, these new rules will:

• Ban out-of-network cost-sharing (like out-of-network coinsurance or copayments) for most emergency and some non-emergency services. You can’t be charged more than in-network cost-sharing for these services.
• Ban out-of-network charges and balance bills for certain additional services (like anesthesiology or radiology) furnished by out-of-network providers as part of a patient’s visit to an in-network facility.
• Require that health care providers and facilities give you an easy-to-understand notice explaining the applicable billing protections, who to contact if you have concerns that a provider or facility has violated the protections, and that patient consent is required to waive billing protections (i.e., you must receive notice of and consent to being balance billed by an out-of-network provider).

No Surprises: Understand your rights against surprise medical bills | CMS

The No Surprises Act protects people covered under group and individual health plans from receiving surprise medical bills when they receive most emergency services, non-emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance...

www.cms.gov

Joseph.

Thank you for the reply, but you are wrong about this. The No Surprise Act does not protect someone when the "voluntarily" go out of network. What the act does protect is OON costs when the insured did not have a choice, such as anesthsiology during an operation, or when an ambulance rushes someone to an OON provider for a true emergency.

 

[LeeV]

Ok I am trying to understand this, clearly there is protection for emergency situations, and for extra services sent out

My case is it was NOT an emergency situation, and they took all my info , But never informed me that it was out of network or there would be out of pocket because it was out of network

Not really sure I see that adressed in this law

Vic 120.

You are correct, based on the information you provided the No Surprise Act does not come into play.

And again, it is not the responsibility of a provider to inform you of your network status, it is the insureds.