Quote:
Originally Posted by chinaski
So, my primary care Doctor referred me to a Pain Management Doctor for my back issues back in August that turned out to be Out of Network for my Insurance. No biggy right? I just did my due diligence and looked up a Provider that was In Network.
After waiting almost 2 months for the initial appointment, and another 2 or 3 weeks for the procedure, I had the procedure (Epidural Steroid).
I got the EOB today and HOLY SHIT. $4500.00. The Insurance only paid out $900.00. WTF.
I've been on the phone for an hour. Apparently the Insurance is saying that the facility is NOT IN NETWORK, even though it still shows that it is on the Website.
Chick at the Office says not to worry, and more than likely the bill will be around $600.00, but still, this is ****ing bullshit. If it's this costly, I'll live with the pain. 
Stay Tuned... |
Who's website does it show in-network? The health plan's website? Or the website for the doc's office?
If it's on the health plan's website, log back on and do a screen shot immediately. This will be your leverage for an appeal.
Actually, if it's on the doc's website, take a screen shot of that, as well. Couldn't hurt. You could file an appeal with DMHC for misleading and egregious billing.
Here's what I need to know: Who is showing the doc as in-network? Did your doc re-issue a referral for the "in-network" specialist? Was the referral approved? Who approved the referral? Which health plan is this? What does the patient responsibility portion state on the EOB (dollar amount)? What is the date on the EOB? What does you evidence of coverage say, in terms of your deadline for filing an appeal?
It sounds like someone either (1) mistakenly approved a referral for for an out-of-network doc or (2) never received a proper approval for the referral.
Which medical group are you enrolled with?