Hospital is in-network but EOB says out of network

This is going to get complex, so bear with me. I live in a small town in Southeast Kansas. Our local hospital is supposedly covered by our insurance, provided by Cox Health Plans and First Health Network providing extended in-network coverage outside of Cox’s main coverage area, which is south-central and south-west Missouri.

Here’s where it gets a little sticky. July 1, 2020, management of our local hospital was moved from HCA Healthcare to the St. Luke’s Health System out of Kansas City. In August, my wife was referred there for PT on her shoulder. We only just the other day received the EoB from Cox regarding this first round of PT, and come to find out it’s being treated as Out of Network service. But even today, if you go to the First Health Network provider directory, the hospital is listed as being part of their network.

We called Cox today, who referred us to First Health. Contacted First Health, and they informed us that the hospital was filing their claims with a different Tax ID number then what is in their files (because of the change of management), it’s now out of network. But we had no way of knowing this, since it is still listed as part of their network within their provider directory. This has left us stuck with an over $2000 bill for this first round of PT – plus since that first round of PT, she has undergone 2 additional rounds. So it’s looking like in total we’re going to have to end up paying nearly 7K in total for this, because our “in-network” hospital is being treated as out of network. What’s more, many of the other hospitals that are part of St. Luke’s Health System ARE covered in-network!

Neither Cox Health Plans nor First Health seemed to have any interest in doing anything about this when we spoke with them on the phone today. Tomorrow my wife will actually go visit the business office at the local hospital to see if there’s anything they can do to help in this situation.

If the local hospital can not do anything for us, what would be our next course of action. I firmly believe this was not our fault – we DID check the provider directory first to ensure our local hospital was in network – and there’s no way for us to know the taxpayer ID was different! Even if we had actually called and asked First Health first, they would have said it was in network, because it is listed in their directory as in network.

Any suggestions on where to go would be greatly appreciated!

submitted by /u/jerutley
[link] [comments]
This is going to get complex, so bear with me. I live in a small town in Southeast Kansas. Our local hospital is supposedly covered by our insurance, provided by Cox Health Plans and First Health Network providing extended in-network coverage outside of Cox’s main coverage area, which is south-central and south-west Missouri. Here’s where it gets a little sticky. July 1, 2020, management of our local hospital was moved from HCA Healthcare to the St. Luke’s Health System out of Kansas City. In August, my wife was referred there for PT on her shoulder. We only just the other day received the EoB from Cox regarding this first round of PT, and come to find out it’s being treated as Out of Network service. But even today, if you go to the First Health Network provider directory, the hospital is listed as being part of their network. We called Cox today, who referred us to First Health. Contacted First Health, and they informed us that the hospital was filing their claims with a different Tax ID number then what is in their files (because of the change of management), it’s now out of network. But we had no way of knowing this, since it is still listed as part of their network within their provider directory. This has left us stuck with an over $2000 bill for this first round of PT – plus since that first round of PT, she has undergone 2 additional rounds. So it’s looking like in total we’re going to have to end up paying nearly 7K in total for this, because our “in-network” hospital is being treated as out of network. What’s more, many of the other hospitals that are part of St. Luke’s Health System ARE covered in-network! Neither Cox Health Plans nor First Health seemed to have any interest in doing anything about this when we spoke with them on the phone today. Tomorrow my wife will actually go visit the business office at the local hospital to see if there’s anything they can do to help in this situation. If the local hospital can not do anything for us, what would be our next course of action. I firmly believe this was not our fault – we DID check the provider directory first to ensure our local hospital was in network – and there’s no way for us to know the taxpayer ID was different! Even if we had actually called and asked First Health first, they would have said it was in network, because it is listed in their directory as in network. Any suggestions on where to go would be greatly appreciated!
submitted by /u/jerutley [link] [comments]Read Morer/HealthInsurance

Leave a Reply

Your email address will not be published.