I received a bill in excess of $6000 from Envision Physician Services, which appears to be charged by an out-of-network physician (through a named physician group) involved in my care during an emergency room visit at an in-network Hospital. I was directed to proceed to an ER following a visit to an urgent care clinic due to pulmonary symptoms, where a large pneumothorax appeared on X-ray imaging. My insurance is a BCBS of Tennessee PPO, and the location of my care was Texas. As my insurance plan is not regulated by the state of Texas, I do not appear to be subject to the balance billing/mediation protections that took effect last year.
I found an explanation of benefits (EOB) for these services, in which BCBS paid ~$1000 to the provider with the rest being classified as ‘non-covered’ with ‘INH’ and ‘XPR’ codes applied.
How do I handle this? Do I file an appeal with BCBS? It really seems as though these services should have been covered due to it being an emergency/life-threatening situation and not having a choice in terms of which physicians specifically treated me. I have never before had to file such an appeal.
Edit: If at all relevant, during my ER visit I was later taken in as an inpatient for several days, with a pleurodesis surgery having been performed.
Further, there were two services listed in my bill from envision:
- ‘9921 – Critical Care 30-74 (Sickness)’
- ‘32160 – Thoracotomy Major Massage’
I don’t know the meaning of the first, but the second puzzled me slightly; I assume it refers to the chest incision and insertion of chest tube (thoracoscopy) for drainage that was done, but ‘thoracotomy major massage’ makes me think of cardiac massage which was not performed, but perhaps it’s just cryptic medical coding.
submitted by /u/dataisinteresting
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I received a bill in excess of $6000 from Envision Physician Services, which appears to be charged by an out-of-network physician (through a named physician group) involved in my care during an emergency room visit at an in-network Hospital. I was directed to proceed to an ER following a visit to an urgent care clinic due to pulmonary symptoms, where a large pneumothorax appeared on X-ray imaging. My insurance is a BCBS of Tennessee PPO, and the location of my care was Texas. As my insurance plan is not regulated by the state of Texas, I do not appear to be subject to the balance billing/mediation protections that took effect last year. I found an explanation of benefits (EOB) for these services, in which BCBS paid ~$1000 to the provider with the rest being classified as ‘non-covered’ with ‘INH’ and ‘XPR’ codes applied. How do I handle this? Do I file an appeal with BCBS? It really seems as though these services should have been covered due to it being an emergency/life-threatening situation and not having a choice in terms of which physicians specifically treated me. I have never before had to file such an appeal. Edit: If at all relevant, during my ER visit I was later taken in as an inpatient for several days, with a pleurodesis surgery having been performed. Further, there were two services listed in my bill from envision:
‘9921 – Critical Care 30-74 (Sickness)’ ‘32160 – Thoracotomy Major Massage’
I don’t know the meaning of the first, but the second puzzled me slightly; I assume it refers to the chest incision and insertion of chest tube (thoracoscopy) for drainage that was done, but ‘thoracotomy major massage’ makes me think of cardiac massage which was not performed, but perhaps it’s just cryptic medical coding.
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