Know before you go! Went to see a physician who has performed a required procedure on me

[Floyd R. Turbo]

several times. Prior to the appointment, I confirmed that he is in my insurance provider’s network. His office confirmed that he is. Toward the end of the meeting when we were scheduling the procedure I asked what my copay would be. Previously it had been a little over $100.

He brought in his billing manager who proceeded to tell me that although the doctor is in network, the facility is not, the anesthesiologist is not, and the pathologist is not.

The facility is owned by the physician and his partners, the anesthesiologist is an employee of the the physician as is the pathologist.

Long story short, my copays would be $1,000. to $1,250. Had I not inquired I would’ve been on the hook for whatever they decided to bill.

[elias7]

1. This is called surprise billing and many states are trying to make this illegal.

[Floyd R. Turbo]

2. It should be. A lot of people wouldn't have asked.

[Midnight Writer]

3. I got hooked on this once. The hospital and surgeon were "in-network". Anesthesiologist was not.

That anesthesiologist got over $4000 for two hours work, all out of my pocket.

[Floyd R. Turbo]

4. Damn! 🤬

[dickthegrouch]

5. I just got hit with that too.

Member relations told me $600 beforehand. The final bill for my deductible and co-insurance is $2539. I’m furious. But there doesn’t seem to be anything I can do about it. I think the medical profession should have to produce a written estimate of all expected charges, and get approval for any increase just like auto shops are required to do.
I’m also asking for a warranty do over on my procedure since it didn’t achieve what it was supposed to. Don’t know how far I’ll get, but if you don’t ask, you can’t receive.

[Floyd R. Turbo]

7. Oh man! 🤬

[Fla Dem]

6. So why are you still not on the hook.

I assume, maybe I shouldn't, you're still going through with the procedure as it's required. So won't you still be on the hook for the co-pay for the anesthesiologist and pathologist? Or are you not going to do the procedure?

[Floyd R. Turbo]

8. I told them I'd find another physician.

[Fla Dem]

9. Good for you! Good Luck.

[Floyd R. Turbo]

10. Thanks!

[beaglelover]

11. They didn't give you the option of having the procedure done at an 'in network' facility?

If not, that really sucks. These facilities owned by the doctors are really messing with the health industry. I used one once and they told me they would take whatever my insurance paid, which is basically insurance fraud. AFter the procedure, I get a bill from the anesthesiologist for like $700. I called them and said I was told they would take whatever my insurance paid, which was like $30. They said but you have not met your deductible yet. I said, no one ever mentioned a deductible to me prior to the procedure. They ended up writing off the bill.

[Floyd R. Turbo]

12. Nope. They only perform the procedure in their own facility.

[IcyPeas]

13. no one in any other country would believe this. we're held hostage by the Medical Industrial Complex

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[Floyd R. Turbo]

14. 👍🏻