Isn't balance billing illegal?

[SecretlyFI]

The No Surprise Act does limit how much you can be charged when you receive care in an in-network facility who uses an out-of-network physician. Your liability should be similar to the liability if the physician were in-network. See details here What is a “surprise medical bill” and what should I know about the No Surprises Act? | Consumer Financial Protection Bureau

+1

This is a problem that exists with the situation you’re describing. I’ve experienced in my work life in healthcare. The anesthesiologist is not contracted by your insurance company. So yes, they can balance bill you. It’s a terrible arrangement since no one picks their anesthesiologist and you are at a network hospital using a network surgeon. If you’re still on commercial insurance, you’re most likely going to have to work out a deal with the anesthesiologist.

I disagree with this, as explained in MichaelB's post and link above. The purpose of the No Surprises Act, which went into effect on January 1, 2022, is to avoid this problem.

And I certainly did not get a good faith estimate of costs I would incur by using this provider. . . . would that be up to the surgery center to provide? Surgery Center and doctor were in network and covered as expected. I'm not entirely sure how I could know what anesthesiologist they would pick in advance. But maybe that is only if you are uninsured?

This is the exact scenario addressed by the No Surprises Act

 

[SecretlyFI]

Well the EOB was never changed and shows I owe money . . . but I called the provider directly and they said I owed nothing . . . they sent me a statement with a zero balance (per my request). No one at either site explained how/why but I'm glad it seems to have worked itself out. Seemed really odd to me that no one could or would offer an explanation.

Looks like the No Surprises Act worked exactly as it's supposed to for you. Glad it's resolved.

 

[swakyaby]

I’m glad it worked out for you, badatmath. The squeaky wheel got the grease.

 

[RetMD21]

I'm not sure badatmath did anything to get greased, It sounds like the usual billing confusion and errors. I had an anesthesiology group fail to file a claim and them bill me for the list price. I called and they gave me some nonsensical story about not having billing information and asking me to send them a copy of my Medicare card by email. I didn't want to solve their problem for them since they had the same information as the center and the surgeon. They eventually billed it at 8 months out. At first I thought it was a scam but it was probably just incompetence. Of course the level one employee is the only one who will talk on the phone and they aren't able to resolve anything.