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So the ER in in network, but the ER Doctor is not, and we now owe and extra $500?

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Fuzz Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Nov-08-09 06:26 PM
Original message
So the ER in in network, but the ER Doctor is not, and we now owe and extra $500?
That doesn't sound right.

My daughter broke her arm on a Sunday evening and we went to our in network hospital ER. Fuck.

Phone calls tomorrow.
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ProudToBeBlueInRhody Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Nov-08-09 06:26 PM
Response to Original message
1. HANDS OFF MY HEALTH CARE!!!!!
What a lovely system teabaggers wish to defend.
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Horse with no Name Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Nov-08-09 06:27 PM
Response to Original message
2. Usually that is all it takes
With all the contract doctors out there these days, that tends to happen.
When it happened to me, the best results came from calling the hospital billing office FIRST. They handled it.
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Fuzz Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Nov-08-09 06:30 PM
Response to Reply #2
6. Yes? How?
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Horse with no Name Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Nov-08-09 06:35 PM
Response to Reply #6
9. Call the business office at the hospital
and let them know this happened. They generally will contact the rent-a-doc agency that they contract their ER physicians through and get the necessary paperwork filled out to accept your insurance.
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Fuzz Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Nov-08-09 06:39 PM
Response to Reply #9
10. Thanks for the advice. Will do that first.
Appreciate it.
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WillowTree Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Nov-08-09 07:48 PM
Response to Reply #9
16. It's not a matter or getting the ER doctors to "accept your insurance".
In fact, the majority of ER doctor's groups and radiologist/pathologist groups intentionally don't join the networks because they know that if they're working out of in-network hospitals, the insurance companies will pay their bills at in-network rates without the contractual fee reductions if they or the patient just calls the insurance company and explains that it was at a network facility and the patient didn't have a choice about the doctor.

If you call the hospital, they're not working it out with the ER doctors, they're working it out with the insurance company. Hence, it's quicker to cut out the middle man and go directly to the source, the insurer, and explain the situation. I never had a case where the insurance company didn't comply with the request under those circumsrances, though UniCare almost always made me fight for it before they backed down, but then, they're the bottom of the barrel, insurance company-wise.
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Horse with no Name Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Nov-08-09 08:31 PM
Response to Reply #16
18. The ER Doctors Group..whether it is Studor or any of the others
most certainly DO negotiate with their providers that they work for to add insurance companies.
The hospital that contracts with these groups has MORE pull because if they get a lot of patient complaints on reimbursement, THEY can cancel the contract on the rentadocs, which is PRECISELY why it is MORE expedient to go through the hospital instead of the insurance company.
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WillowTree Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Nov-08-09 11:58 PM
Response to Reply #18
21. Whatever. You obviously believe yourself to be the authority.
I've only worked in various areas of health care reimbursements/collections at all levels for over 35 years.
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Horse with no Name Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Nov-09-09 12:02 AM
Response to Reply #21
22. Oh no--I wouldn't DARE surpass YOUR authority
:rofl:
As I said--I had the same problem. I solved it with a phone call to the hospital billing office. A phone call. Just one.
You stated that you had to wrestle with the insurance company for months.
So, by all means, advise someone ELSE to wrestle with them for months because you are the supreme, omniscient authority.
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WillowTree Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Nov-09-09 12:27 AM
Response to Reply #22
24. By all means, please cite where I EVER said....
Edited on Mon Nov-09-09 01:03 AM by WillowTree
...that I "had to wrestle with the insurance company for months". Or that it ever required more than one phone call. Fact is, I'm far too good at what I do for that to have to happen. What I did say was that ONE insurance company would make me argue the point, but ultimately they backed-down every time.

Look, I'm glad that you were able to resolve your problem by going through the hospital. Having been involved in actually having to DO the collections for these very types of physician's groups in varying capacities for years, my experience has been that going to the folks who are ultimately going to have to cut the checks is more efficient. YMMV.
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Horse with no Name Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Nov-09-09 12:40 AM
Response to Reply #24
25. I'm sorry for the snark
I shared my experience.
I only hope that the OP has luck in whichever method he decides.
I only know what worked for me and others who had the same problem.

Peace.
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WillowTree Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Nov-09-09 01:02 AM
Response to Reply #25
27. No offense taken.
All any of us want is for the OP to get the situation resolved, and with as little hassle as possible.

Have a good week, OK?
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Horse with no Name Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Nov-09-09 01:05 AM
Response to Reply #27
29. Thank you. You too.
:hug:
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WillowTree Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Nov-08-09 07:07 PM
Response to Reply #2
15. Call the insurance company.
The hospital and ER doctors bill separately and with most claims operations automated now, it's more than likely that they missed the fact that the treatment was given at an in-network facility. If you call them and tell them that and that you had no choice regarding the ER docs, more often than not they'll re-process the bill at in-network rates. I had very good luck talking to them in such cases when I was working in a phycian's billing service.

Same hold true if a radiologist, pathologist or anesthesiologist is out-of-network, but working in an in-network hospital.
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ctaylors6 Donating Member (362 posts) Send PM | Profile | Ignore Sun Nov-08-09 08:49 PM
Response to Reply #15
19. I agree - call the insurance company. That worked easily for me once.
Edited on Sun Nov-08-09 08:50 PM by ctaylors6
A few years ago, I had a surgery in a network facility with a network surgeon. The in-network hospital contracts with a huge group of anesthesiologists. Some of them were network, some were not, and I didn't have a choice about the anesthesiologist. I had called my insurance company in advance of the surgery and they said everything was cleared. It ended up the anesthesiologist for my surgery was out of network. One ten minute phone call to BC/BS, and they simply reclassified the anesthesiologist as in-network. So I owed only whatever would have been owed for an in-network anesthesiologist. They said that since I had gone to an in-network hospital and didn't have control over the anesthesiologist, they would just do the reclassification. I spoke to one person, and I'm not sure they even put me on hold.

Hope it works out well and easily for you! Hope your daughter's arm mends quickly too!

Edited to add: I read in later post her arm is all better -- I'm so glad!
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Muttocracy Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Nov-08-09 06:27 PM
Response to Original message
3. I hate those games.
Edited on Sun Nov-08-09 06:27 PM by Muttocracy
I had minor surgery years ago, called around in advance to be very careful that the hospital, surgeon, procedure, etc. would all be covered. A few weeks later, they tried to make me pay a big bill because one of the anesthetia nurses wasn't "in-network". I won that fight but it took a ton of time and paperwork.
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greenbriar Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Nov-08-09 06:29 PM
Response to Original message
4. oh yea, I was in the in network hospital this summer but they sent the labs
including the daily dracula draws to an "out of network" lab

WTF
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HughMoran Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Nov-08-09 06:29 PM
Response to Original message
5. The games the insurance companies play these days are absolutely maddeningly infuriating
It's amazing that anybody could support such a system.
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inna Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Nov-08-09 09:02 PM
Response to Reply #5
20. so, you're finally starting to see the light - thank god.
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MiniMe Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Nov-08-09 06:31 PM
Response to Original message
7. Hope your daughter is OK
Like YOU can choose what doctor you can get in the ER.
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d_r Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Nov-08-09 06:31 PM
Response to Original message
8. that happened to us
my wife had an emergency appendectomy. I even called before hand to double check the ER at that hospital was in network. But the surgeon was not. He was the surgeon that was there. So finally, they were able to take that and fill in another code, and get it through. But then the anesthesiologist was not in network. And even though she was at the hospital for almost 48 hours, the hospital would only bill it as an out-patient surgery, which meant we got a higher co pay, etc., etc., etc.
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madrchsod Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Nov-08-09 06:40 PM
Response to Original message
11. there`s another game the insurance companies are playing
instead of paying the hospital and doctors in 30 days they use the out of network or any minor error in the billing to delay payment. it took my hospital 4 months to pay my bill. the insurance company looked for every error they could find.during that time the bill was turned over to collections because the hospital policy. i had several discussion with the person that ran the billing dept. she said the insurance companies are basically screwing everyone involved.

start with the hospital`s billing dept. ask them if they have any problems with insurance companies paying clams on time. it`s best to get them on our side because you maybe on a long fight with the insurance compnay...good luck.hope your daughter feels better...
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Fuzz Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Nov-08-09 06:46 PM
Response to Reply #11
13. Funny you should mention that, my daughter's broken arm is already healed.
Edited on Sun Nov-08-09 06:48 PM by Fuzz
This bill just arrived Friday, (edit) I'm sorry, yesterday.
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Missouri Girl Donating Member (123 posts) Send PM | Profile | Ignore Sun Nov-08-09 06:44 PM
Response to Original message
12. Call the hospital and then your state department of insurance
Most carriers will honor or pay the claim at in-network for ancillary services if the hospital is in-network. RAPAL services are the most common - radiology, anesthesiology, pathology, and laboratory. But, I have seen it happen for ER docs as well. If the hospital can't fix - call your state department of insurance and file a complaint against your health insurance company. So long as you are insured under a non-self-insured plan (not an ERISA plan), your state agency may be able to help.
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peace13 Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Nov-08-09 06:50 PM
Response to Original message
14. A phone call and a fax from you should correct the problem.
By all means don't pay the over charge!
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annabanana Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Nov-08-09 07:53 PM
Response to Original message
17. That happened to us. I was shocked.
We got a bill for $700 for a doctor that saw my husband in our local ER. The hospital had accepted our insurance card, so I thought that that would be the end of it except for the $50 ER co-pay.

I made a public stink about it. There are enough hospitals in our area that we could have reasonably gone to a different one, and they are shy about bad publicity. I also got our insurance co. to "review" their decision.

We lucked out and the ins co. sent the doc a little more $ and told us we were off the hook. It could have gone either way.

It should DEFINITELY be against the law for the hospital to accept the insurance at the ER, and for the "ER doctor" to refuse it.
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Skittles Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Nov-09-09 12:05 AM
Response to Original message
23. yup
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JesterCS Donating Member (627 posts) Send PM | Profile | Ignore Mon Nov-09-09 12:51 AM
Response to Original message
26. Most hpspitals
contract their doctors, easier that way for them, plus the doctors get more money that way.
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TicketyBoo Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Nov-09-09 01:03 AM
Response to Original message
28. A personal experience.
We pay our son's health insurance premiums since he just graduated from college this past year and hasn't yet found a position with benefits. His policy is supposed to include a $30 co-pay for doctor visits.

He was feeling lethargic and suspected that his thyroid medication dosage needed to be increased, so he went to the doctor. He told the doctor that his mother has diabetes and his father has pernicious anemia, so with his lethargy, it could be a wise move to check for those conditions, since both have a hereditary link. The doctor ran those blood tests along with the thyroid test, and our son paid the $30 for the visit on his way out the door.

When he got the bill, the doctor's office had coded the visit as "preventative" and, handwritten across the bottom of the bill was "BCBS will not pay for preventative care. This bill is your responsibility." and they charged him $191 for the office visit, giving him credit for the $30 he had already paid. One of the drug tests was coded as "preventative," too, meaning that it would not even apply to his $1,000 annual deductible.

He called the doctor's office and they agreed to recode the visit, but meanwhile, being young and dumb, HE PAID THE BILL. BCBS paid the doctor's office, and the doctor kept the money. So the doctor got paid by both their patient and the insurance company. This visit was in July, and the doctor still has both his money and the money from the insurance company.

Argh!
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