I had an operation done and the doctor's office told me they got authorization for it. But nobody told me the facility they did the operation in was out of network of my insurance, so now I'm going down for like 30k. Lovely. How is your day going?
EDIT: Looks like I will only have to pay like 2k according to the lady at the hospital
Signed, million man.
Have you read the No Surpises Act?
It’s specifically designed for people who have health insurance and received care from an out-of-network provider or facility knowingly or unknowingly and are now being billed for the balance between the out-of-network charge and what their insurer will cover in-network.
https://www.cms.gov/newsroom/fact-sheets/no-surprises-understand-your-rights-against-surprise-medical-bills
https://natlawreview.com/article/surprise-billing-regulations-out-network-providers-network-facilities
There is a clock running on your deadline to initiate a billing dispute and complain about the lack of appropriate advance notice re the predicted charges. Read about the Act online so you know what steps to take to avoid waiver of your rights. I suspect that asserting your rights under the Act will give you the leverage get them to compromise the bill to an amount you can tolerate (and akin to what your out-of-pocket costs would’ve been if covered by your insurance). Your state may have an even better no surprises law and you should see what your HR person can do to help if you have an employer-based insurance policy.
You all are missing the most vital point. This bill does not cover “Out-of-Network” hospitalization. It pertains to necessary ER services until the patient is stabilized enough to be transported to an “In-Network” facility. It pertains to anesthesiologists et al who are “Out-of-Network”, but visits an “In-Network” facility. There are healthcare facilities which may have several physicians on staff. The facility may be “In-Network”, but all of the physicians may not be “In-Network”. It’s up to the enrollee to inquire, or it used to be.
It happened to my husband at least 25 years ago. Something went amiss with one of his eyes. We of course chose an “In-Network” ophthalmologist for treatment. He had several visits, but during one of those visits his physician became ill so he was treated by another associate. We received a huge statement due to the treating fill-in was “Out-of-Network”. I phoned the insurance company which was the carrier of the county school system. I explained the situation, they waived the cost so all was covered except for the co-pay.
Oh man, that’s brutal.
I hope you can sort it out so you’re not left with that massive bill. Hope you’re recovering well from your operation too.
You know what I smell?? I smell some litigation issues perhaps because that's not your fault you know??
shareDefinitely seek legal advice.
shareI wouldn’t pay it.
sharePer the link Keelai provided:
https://www.cms.gov/medical-bill-rights
This page applies to all people in the United States who use most types of private health insurance.
The No Surprises Act is a federal law that went into effect on January 1, 2022.
The Act protects you from unexpected out-of-network bills from:
Emergency room visits
Non-emergency care related to a visit to an in-network:
-Hospital
-Hospital outpatient department
-Ambulatory surgical center
-Air ambulance services
These protections apply to you if you have health insurance through an employer (including a Federal Employees Health Benefits plan), the federal Health Insurance Marketplace, a State-based Marketplace, or other individual market coverage.
__________
I hope you read through the information on that website. To me, it sounds like you are protected.
The key words are “ Emergency room visits”. I don’t believe it pertains to hospitalization. Every employee insurance we’ve had states it’s up to the enrollee to inquire “Is the physician, hospital, etc. In Network?” These are usually the lower cost HMOs. When my husband’s salary increased we switched to the higher cost PPO. Any physician, any hospital and without referrals.
This holds true for Ocare. My granddaughter has a form of Ocare and she is bound by what physician is “In Network”.
“Non-emergency care related to a visit to an in-network.
I wouldn’t give credence to anything that twit Keelai posts. One of the worst haters and race warlords on this site!
shareSo sorry you got caught up in this mess, but when we had the lower cost HMO it was printed in the manual it was our duty to inquire about who and what facilities are “In Network”. This is why I don’t have a Medicare Advantage Plan. I’m paying more due to having a supplement plus Medicare. I don’t have a drug plan, Part D, so I pay out of pocket. I don’t want to worry about finding myself in your situation. My primary and specialists are not beholden to “In Network” or the allowable amount of meds to write.
shareTHAT IS AN AMAZING EDIT...STILL SUCKS THOUGH...I NEVER NOW WHAT TO SAY WHEN I CARE ABOUT SOMEONE...SO....LOVE YOU,BRO...KISSES AND BUTT SQUEEZES.😘😉
share