Recently had major surgery and have received around $6000 in surprise bills (Anesthesiologist and Hospitalist). These claims are being treated as Out-of-Network which means that they are essentially uncovered since I have a separate OON deductible and Out-of-Pocket limit. If they were in-network, then my responsibility would be zero since I’m already way over the Out-of-Pocket limit with everything else.
California has a law (AB-72 info link) that prevents this, but it apparently does not apply to out-of-state insurance companies. Although I live and work in CA, my employer is HQ’d in Tennessee so our health plan is regulated by TN, which does not have a comparable law. The federal law does not take effect until 2022.
Anyone else encounter this situation? Any advice on how to deal with it? Thanks in advance.
https://health-access.org/wp-content/uploads/2019/07/AB-72-Fact-Sheet_updated-7.22.19.pdf
EDIT: FWIW, the hospital was confirmed to be an in-network facility prior to the surgery. I attempted to find out about the anesthesiologist prior to the procedure, but they were not able to tell me anything.
My insurance is a PPO.
submitted by /u/PHL1365
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Recently had major surgery and have received around $6000 in surprise bills (Anesthesiologist and Hospitalist). These claims are being treated as Out-of-Network which means that they are essentially uncovered since I have a separate OON deductible and Out-of-Pocket limit. If they were in-network, then my responsibility would be zero since I’m already way over the Out-of-Pocket limit with everything else. California has a law (AB-72 info link) that prevents this, but it apparently does not apply to out-of-state insurance companies. Although I live and work in CA, my employer is HQ’d in Tennessee so our health plan is regulated by TN, which does not have a comparable law. The federal law does not take effect until 2022. Anyone else encounter this situation? Any advice on how to deal with it? Thanks in advance. https://health-access.org/wp-content/uploads/2019/07/AB-72-Fact-Sheet_updated-7.22.19.pdf EDIT: FWIW, the hospital was confirmed to be an in-network facility prior to the surgery. I attempted to find out about the anesthesiologist prior to the procedure, but they were not able to tell me anything. My insurance is a PPO.
submitted by /u/PHL1365 [link] [comments]Read Morer/HealthInsurance