Quote:
Originally Posted by peteremsley
I'm really interested in this, but unfortunately not knowledgeable at all.
I am in the same situation, though on a much smaller scale. I was very careful to stay in network for my broken kneecap surgery, but have ended up with a bill for around $2k from an anesthesiologist who just showed up on the day. Just got the bill a few weeks back. Not really sure how to proceed, but I'm not writing a check until I've dug around a bit.
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Realistically, could you have undergone kneecap surgery without the anesthesiologist?
It's OK for you to never have met the anesthesiologist until the day of surgery, nor to have any follow-up contact with him/her afterwards. But I'm guessing that's not what you're contesting.
It's not uncommon for the anesthesiologist to be out-of-network. After all, if they feel that your insurance company pays too little for what they do, why should they have to sign a contract with said insurer? And given the myriad of insurers out there, isn't not practical to schedule a surgery day where the surgeon and anesthesiologist (two separate businesses) are all on matching networks.
But if you feel the bill is out of proportion to the service provided, then you can try to negotiate an appropriate rate with the anesthesiologist. Find out what he/she would have been paid had he been within network and see if he/she will take it. Call up your insurance company and ask them (with the diagnosis and procedure codes in hand.) What would Medicare have paid? (Though I don't know who you're going to ask to figure out the answer to that question.)
Figure out if your state allows for balance billing. That's where the patient is liable for any part of the bill that the insurance company won't pay. Hopefully for you, the answer is no.
Find out if there's any state stipulation that the facility has to provide an anesthesiologist within network. For example, when the surgery center where I work was recertified by either Medicare or Blue Cross a few years back, the facility had to ensure that there would always be a Medicare/Blue Cross anesthesiologist on staff. That was a condition of recertification. See if that's true in your state. And if it is, push the anesthesiologist to accept whatever your insurer would have paid (or at least try to negotiate something in between).
But in the end, and again this depends on state laws, if the anesthesiologist is out-of-network and has billed $2K, you might be legally liable for $2K.