Balance Billing question

[bmcgonig]

I ended up getting an appendectomy at the beginning of December. Had a CT scan one afternoon after having some abdominal pain, and after that was told to go to the nearest hospital ER. So I went, was admitted, and had my appendix out the next day. Seems like everyone was in network (so far..although I haven't gotten all the bills) except the anesthesiologist, who billed me an extra $800 that the ins co didn't cover. I'm in CA and have a non ACA PPO from Blue Shield. I've heard/read different stories and accounts about whether ER visits are subject to balance billing, and I was wondering if anyone knew for sure if an appendectomy, which I would imagine is considered emergency surgery, is subject to balance billing?

I really have no idea what I signed when I was in the hospital, so I may have waived my entire bank balance away 😁


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[irishgal]

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[pb4uski]

State Restriction Against Providers Balance Billing Managed Care Enrollees | The Henry J. Kaiser Family Foundation

[bmcgonig]

Thanks PB. What a crazy system. There are two regulators of insurance in CA. Balance billing for ER services are disallowed for one, but not the other. E.g, looks like Blue Cross PPO would be disallowed, but Blue Shield PPO would not. All HMOs are disallowed.

Still not sure whether a surgery following an ER is disallowed or not, but in my case with Blue Shield it may not matter.

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