I have been undergoing evaluation for a bariatric procedure since the spring. I was assigned a coordinator at the facility to guide me through the process for medical and insurance clearances. My initial insurance review showed that I was fully covered, great! I was then assigned to Dr.A, who I met with 3 times over 12 weeks. 2 office visits and an endoscopy. Each time the facility billed me for a $20 copay, my in-network rate.
Fast forward to the week before my surgery, I get a call from facility saying that they made a mistake. Dr.A is actually out of network, and that I will be transferred to another doctor at the practice. I have one intro appointment with Dr.B (another $20 copay) and am luckily able to keep my surgery date without disruption.
Now after the surgery I am looking at my insurance claims to date. Ins is saying that I owe over $2000 for the 2 visits + endoscopy with Dr.A because she is out of network.
I’m planning to call the office for more information, but want to be prepared. Am I fully on the hook for these new charges to Dr.A, or can I fight this given that this was an error on their end?
Btw, I only caught the discrepancies in payments because Ins notified me that my surgery claim was denied and I’d be on the hook for $45K. It looks to be a clerical error thank goodness, but after almost fainting I am now reviewing all claims with a fine tooth comb.
submitted by /u/itchyback2021
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I have been undergoing evaluation for a bariatric procedure since the spring. I was assigned a coordinator at the facility to guide me through the process for medical and insurance clearances. My initial insurance review showed that I was fully covered, great! I was then assigned to Dr.A, who I met with 3 times over 12 weeks. 2 office visits and an endoscopy. Each time the facility billed me for a $20 copay, my in-network rate. Fast forward to the week before my surgery, I get a call from facility saying that they made a mistake. Dr.A is actually out of network, and that I will be transferred to another doctor at the practice. I have one intro appointment with Dr.B (another $20 copay) and am luckily able to keep my surgery date without disruption. Now after the surgery I am looking at my insurance claims to date. Ins is saying that I owe over $2000 for the 2 visits + endoscopy with Dr.A because she is out of network. I’m planning to call the office for more information, but want to be prepared. Am I fully on the hook for these new charges to Dr.A, or can I fight this given that this was an error on their end? Btw, I only caught the discrepancies in payments because Ins notified me that my surgery claim was denied and I’d be on the hook for $45K. It looks to be a clerical error thank goodness, but after almost fainting I am now reviewing all claims with a fine tooth comb.
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