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And as far as in or out of network - the ob/gyn that we were seeing was accepting our insurance and said that they deliver at this particular hospital and we would need to get there on d-day. So the og/gyn had our plan details and accepted us and saw us for many months leading to the delivery. Am i wrong to assume that he would have denied to work with us if our insurance didn't cover his office and the hospital that he would be delivering at??
Did you check with the hospital? And it sounds like you received an EOB (Explanation of Benefits).
Call the insurance company on Tuesday and get the story straight before you freak out. Have a nice weekend with your new baby and don't worry until you have to.
Did you check with the hospital? And it sounds like you received an EOB (Explanation of Benefits).
Call the insurance company on Tuesday and get the story straight before you freak out. Have a nice weekend with your new baby and don't worry until you have to.
Jerseyt719 offers the best advice for the moment. Don't freak out!
It often takes half a year or longer for the hospital to settle with the insurance company. Then you'll find out if they really expect you to pay more. But as others have said, if there's more to pay, it probably won't be a lot.
Total amount: 24,739
PPO allowance: 13,906
Healthnet payment: $0
Account balance: $10,833
Also, I just logged into my Healthnet account and it shows the claim for $24,739 as denied and below that it also says "patient responsibility for this claim = $0.00"
So it doesn't make sense that they denied the claim and say patient responsibility is zero dollars as well??
It means that Healthnet is going to pay the 24739 minus the 13906 but has not done so yet. Insurance companies are notoriously slow to pay and may take more than 90 days. How long ago was the delivery?
Every Hospital has a dept for helping you with understanding your bill.The thing comes down to what your deductible is and what your coinsurance is if you have any. You are not responsible for anything else I had 2 surguries last year and with insurance , my own deductables and coinsurance it was $22K out of pocket in a 12 month period. The anesthesiologist is usually a **** and will try that I am not in network BS you sometimes have to even sue the bastards but this is how it has become with A-hole ins co. I swear sometimes I think next time I am gonna tell them I have no insurance and I am illegal and they might not charge me!!!!!!!
The anesthesiologist is usually a **** and will try that I am not in network BS you sometimes have to even sue the bastards but this is how it has become with A-hole ins co. I swear sometimes I think next time I am gonna tell them I have no insurance and I am illegal and they might not charge me!!!!!!!
Sounds like you being the ****. When you go to work, dont you expect to get paid? What if your clients, or boss, or whoever came to you and said "I want you to work, but I am not going to pay you for it?" You wouldn't have a problem with that, now would you?
Here is the problem, insurance company "X","Y", and "Z" pay you $100 for a specific procedure. Now comes along insurance company "W" who says they only want to pay you $60 for the same procedure. If you accept the $60 from them, then "X", "Y", and "Z" come to you and say that since you are accepting $60 from "W", we are only going to pay you $60 also. The other option is to tell insurance company "W" to take a hike. Now you dont accept insurance company "W", so any patient who uses insurance company "W" is now coming to you out of network, and you are responsible to pay. This is not just with anesthesiologists either. As I said, one of my hospitals does not accept Aetna for anything. (BTW, Aetna is often "insurance company "W"".) It is also common among ER Docs and Radiologists to not accept certain insurances. It is sometimes our only recourse. Otherwise, these insurance companies would walk all over us more than they already do. It is the patient's responsibility to make sure their doctors accept their plan. It is not a secret. A simple phone call to the office does the trick. Heck, you could just ask prior to going in the operating room. It sounds like you are too lazy to do your due diligence and then you expect everybody else to pay for your laziness.
You can try saying you're an illegal alien and dont have insurance, but unless it is an emergency, nobody is going to work on you for free. That includes the surgeon, anesthesiologist, and the hospital and it's employees.
Another tip for you, most anesthesiology groups at outpatient surgical centers dont take a lot of insurances, and some, not at all. Outpatient surgical centers are considered a "luxury" as opposed to having surgery in a hospital.
Most Hospitals require the anesthesiologists to accept whatever insurance the hospital accepts (unless they can show the insurance company is being completely unreasonable). Outpatient surgery centers dont have such requirements.
I read somewhere that Anesthesiologist have the lowest insurance acceptance rates of any speciality. Of course, some of that could be because they have people between a rock and a hard place -try having surgery without one.
I do know that at St. Peters, where our kids were born, it was all billed together. The same thing did not happen to a friend who had surgery on Staten Island and was hit with a massive bill from the anesthesiologist who assisted during her surgery.
I really do think they should accept the same insurance as the hospital and primary surgeon or practitioner as it is hardly practical to look for one independently.
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Jerseyt719 offers the best advice for the moment. Don't freak out! 
