Medical Billing Forum
Billing => Billing => : rjeaton June 07, 2010, 10:05:39 PM
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My wife recently had a baby and we made sure we went to a hospital that was in the PPO network which would cover most of our bills. Later we received an anesthesia bill apparently because the anesthesiologist isn't in the network although the rest of the hospital is. I really don't fully understand this do we need to bring our own anesthesiologist with us when we are running to the hospital for the birth? I looked up areas covered for the hospitals around us and none of them had anesthesia listed. I feel like we have been mislead and then robbed because of it. Anyone else run into the same issues?
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It sounds like you tried to cover all of the bases, but unfortunately there really isn't much you can do now. Did the bill get submitted to your insurance? There may be out of network benefits.
Michele
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Depends on your plan, if you have a self-funded or an ERISA based benefit plan call your plan administrator. Those are sneaky PPO's!! I've had it happen myself, go to a hospital in my network only to get a bill from the doctors who are not. IN MOST CIRCUMSTANCES you can holler at the insurance company and get this appealed, especially if you had no say in who performed the surgery or provided the anesthesia. Often with labor/delivery you are at the mercy of whoever is on staff at that time, and that right there is a basis for an appeal.
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My advice is to call the insurance and tell them this bill is for labor and delivery and she was inpatient at a participating hospital. That should take care of the issue - its a case of " Non-Par Hold Harmless."