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Old 03-11-2013, 08:54 PM
 
447 posts, read 1,040,061 times
Reputation: 756

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Had to go to the ER room last month. I went to [Mod cut: no hospital name, please - consumer complaint] hospital, because it was "in-network". They fixed me up and I'm satisfied with the treatment experience.

However, the bills are coming in now and the ER doctor, who saw me at the "in-network" hospital says that he is NOT "in-network" and so his portion of the bill is not covered under my insurance plans "in-network" rates.

What a bunch of malarkey! The hospital is claiming that the Dr. is a contractor and is not obligated to participate in the insurance plans.

What's the point of going to an "in-network" hospital if the Dr's are not in network? How is this my problem? If a Dr. is contracting for a hospital, then they should be obligated to honor the "in-network" plans for that hospital.

Has anyone had success in fighting these charges?

Last edited by elnina; 03-12-2013 at 12:02 PM..
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Old 03-11-2013, 09:28 PM
 
Location: Texas
2,847 posts, read 2,488,123 times
Reputation: 1774
Good luck. Had a friend that went through this last December. Same thing, same hospital, 2 days in, and $15,000 in bills, some in network, others not, legal advice told him to bite his lip and pay. That's the way it works. Swell system we have isn't it.
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Old 03-11-2013, 09:51 PM
 
Location: San Antonio, Texas
3,503 posts, read 19,825,970 times
Reputation: 2771
Call the insurance company and report the problem. Explain, in nice terms, what was done and how the ER doctor states he is not in network. Ask how you can get an in network price on the services when you complied with the plan and went to an in network ER.
The insurance company may or may not be able to help. It's worth a try.
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Old 03-11-2013, 10:24 PM
 
14,637 posts, read 34,902,336 times
Reputation: 6683
You should be able to appeal that successfully, and if not, keep going up the chain until you get a supervisor who will do the right thing.
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Old 03-11-2013, 10:45 PM
 
18 posts, read 35,250 times
Reputation: 11
Appeal for sure. I went through the same thing with my son. I had UHC at the time and they had a whole bunch of hoops that I had to jump through. But keep at it, they should cover the dr. fees.
On a side note, a friend of mine told me that methodist is not doing well financially. And sure enough I was able to negotiate a reduced bill if paid in full for my portion of the expenses. Something that might be possible with alot of providers, but they seemed very willing.
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Old 03-12-2013, 08:50 AM
 
Location: San Antonio, TX
54 posts, read 190,470 times
Reputation: 39
I didn't know about this. I went to my insurance's website and it does have a warning about this.
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Old 03-12-2013, 08:56 AM
 
Location: San Antonio
2,817 posts, read 3,444,185 times
Reputation: 1252
this news makes me sick. i went into the er with my kid, had him check in, then i decided to leave because he was fine. i got a bill for that. had to pay. no wonder people hate the insurance companies.
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Old 03-12-2013, 09:02 AM
 
Location: USA
4,426 posts, read 5,304,570 times
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This sound more like the hospitals fault to me. The insurance company negotiates special rates then Methodist brings in contracted doctors who don’t charge that rate…or did I miss something?
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Old 03-12-2013, 09:11 AM
 
447 posts, read 1,040,061 times
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Quote:
Originally Posted by rynetwo View Post
This sound more like the hospitals fault to me. The insurance company negotiates special rates then Methodist brings in contracted doctors who don’t charge that rate…or did I miss something?
You've got it right. That is what happened and Methodist is saying that's the way it is, and that detail was apparently buried somewhere in the consent form I signed at check-in.

I'm still flabbergasted. Going to a in-network hospital, I expect all my treatment there to be in-network. Is one supposed to ask every nurse or Dr. who enters the room if they are 'in-network'?
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Old 03-12-2013, 09:20 AM
 
Location: USA
4,426 posts, read 5,304,570 times
Reputation: 4116
This would be a perfect story for one of the local news defenders if you can't get it resolved through traditional phone tag.
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