What?!

[Mab 44]

So United Healthcare isn't going to cover my anesthesia because they say it was out of network provider.

I DID NOT GET TO CHOOSE MY ANESTHESIOLOGIST.

I owe over $2000. Perhaps I should have just downed a bottle of whiskey and chomped down on a wooden bit.

[Lissa 2,631]

Appeal it (again, if that's the case). You can't have an approved surgery without anesthesia and, no, you don't usually get to choose who does that part!

[Wheetsin 714]

Ah yes, I've seen this more times than I can count.

Very recently a friend of mine had preemie twins. The babies were sent to a NICU, which was approved, but the actual staff members at the NICU were not. She assumed that if the facility is approved, then the people who work there are too. Not the case. They were in there for 4 months and then hit with a bill for hundreds of thousands of dollars. I'm helping her work through it now, but she is going to end up with a significant OOP loss.

You can appeal it. They will likely tell you that you should have coordinated with the hospital, found out who their staff anesthesiologist would be, and ensured that person was in network. That's what they say, but in reality, who actually thinks to do that? It's silly.

You can also pursue "reasonable and customary" reimbursement. Unless your policy has something specifically saying they won't, even if you use an out of network provider, your insurance company should reimburse the lower of the actual bill, or what they deem a reasonable and customary charge. They have big tables of charges and these reimbursements are non-negotiable. Usually an out of network provder charge is more than the R&C charge, but every now and then it is not.

BTW, here's the UHC policy on OON/R&C reimbursement.

http://www.uhc.com/l...rk_benefits.htm

[crystal525 26]

That always happened when I had United. Call them ... If the hospital was in network it should be covered.

[Webchickadee 716]

I'm from Canada and we have national health care here (though each province runs it individually). I'm going to Mexico for my surgery because the wait list here is 5-7 years (!) and they only do the Roux-en-Y Gastric Bypass (which also bypasses part of the intestine).

But all that being said, I still am EXTREMEMLY happy to have our national health care. I would never run into this kind of bureaucratic lunacy. Why would you think for a second that your anesthetist (that' what we call anesthesiologists in Canada), or your nurses, doctors, etc. would NOT be covered by your insurance, if they approved you to go to the hospital where they work!

That's nuts!

I'm really sorry you're running into this nightmare. However, the $2K is a small price to pay for the fantastic new you you're going to enjoy for the rest of your life! That's why I chose to self-pay ($6K plus flights and other expenses), rather than wait another 7 years to have a surgery I don't even want because that's the only one covered.

Try to look on the positive and remember, it's for your health. And you're worth it! And that you've learned a valuable lesson about looking into ALL the loop-holes in the future, no matter how nutty they are!

[Mab 44]

I have absolutely no plans to pay this. Ever. Regardless of the outcome of my appeal. I've already paid close to $4000 out of pocket.

[Webchickadee 716]

Just be careful with not paying the debt (hopefully you won't be asked to, as you'll win the appeal!). You don't want to hurt your credit rating. $2K will seem like a pittance if you need credit in the future and can't get it because they've messed you up!

[Wheetsin 714]

Here's a link to a site with good info. Nothing new, but at least it can confirm some of what you're being told. http://www.fairhealthconsumer.org/reimbursementseries/whybill.aspx

Unfortuntately the hospital being in network has nothing to do with it, it's about the individual physician.

It's an unfortunate sort of loophole that leaves people "screwed" all the time. If you fight it, have your insurance company act as your advocate. You're paying them. Also see if the hospital has a patient advocate. I had a billing snafu with the anesthesiologist a few years ago (not a network issue, but a technicality in how it was billed). I was getting nowhere fast, after months and months. I let the hospital's patient advocate take a stab, she was "friends" with someone in my insurance company's office, and the whole thing was resolved in 2 weeks.

You might want to call the phsyician's billing company (on your statement, not necessarily the hospital) and tell them you're appealing the charge. They can note that on your records and withold you from collections (most will give you a decent grace period).