Even though I've read many stories about billing abuses, my interaction with MDs has been mostly finding them as allies, helping us find ways to get around the obstacles. Not so with labs or specialized clinics.
Ive read some nasty stories on how people attempt due diligence and make sure the doctor and facility are in network, and then they find out afterward that the anesthesiologist was out of network, and get smacked with a higher cost. Do you have to call everyone including the custodian who cleans up the mess to verify he is in network,too? My only one encounter with an anesthesiologist was my one knee scope. He asks where I want the injection. I said, how the hell am I supposed to know? Aren't you the doctor?
Katsmeow said:A few years ago I had to have my gall bladder out. I really called around before hand to make sure the anesthesiologist was in network. They were not. Unfortunately, none of the anesthesiologists were in network at any hospital my surgeon practiced at. And, I was told by the hospitals that this was true for every hospital in the area. However, someone told me that sometimes the health plan makes an exception for anesthesiologists. I looked and indeed it provided that if the surgeon and hospital were in network then they would pay (I think) anesthesiologists, radiologists and pathologists who were out of network and I would not be liable for the extra amount.
After the surgery, I remember the insurer paid my surgeon something like $600 on a $6000 surgery fee and paid the anesthesiologist, etc. However, there was a charge for an asst surgeon that was out of network and they paid something like $300 of his $3000 fee telling me I was liable for the remaining $2700. I screeched since no one had told me about the asst surgeon (I found out these are assigned by the hospital and my surgeon had no choice in it and none of them are in any network). I argued to the insurer they should treat them like anesthesiologists even though they weren't on the list. Thankfully, the insurer agreed to do so. I don't know what they worked out with the asst surgeon but I never received a bill from anyone so apparently the insurer did work it out.
That is just plain crazy. .......
Even though I've read many stories about billing abuses, my interaction with MDs has been mostly finding them as allies, helping us find ways to get around the obstacles. Not so with labs or specialized clinics.