doctors in network wih hospitals out of network?

[bmfraser]

doctors in network with hospitals out of network?

What is the name of your state? MA

Hi.

During my wife's pregnancy I changed jobs which changed my insurance. I made a point of making sure that both our primary care physician and her OBGYN was in the network. The last two months were on the new insurance. After the delivery, our insurance is now claiming that the hospital is not in network. I don't understand how the OBGYN could be in network but the hospital she deliveries babies in is not It never occurred to me that I needed to confirm the hospital in addition to the doctors.

The hospital and the OBGYN are taking no responsibility for not indicating to us that the hospital was out of network. We are now receiving large bills from the hospital for an out of network deductible and limited coverage after that. Is there anything we can do?

 

[cbg]

Probably not. Many if not most doctors have privileges at more than one hospital, and it is YOUR responsibility, not that of the doctor, the hospital, or your employer, to determine what is and is not in network. The hospital and the obgyn are not taking any responsibility, because it is NOT their responsibility.

A doctor is hardly going to give up privileges at a given hospital, because the hospital chooses not to participate with all the same insurance carriers he does. When I worked for a national insurance carrier, as long as the doctor had privileges at ONE network hospital we would accept him. But it was up to the patient to be certain the doctor admitted him/her to the network hospital. Many insurance carriers have more than one network, and certain hospitals and doctors may be in network to one and out of network to another. The doctor doesn't know which network you are covered under.

I'm sorry it didnt occur to you to check the network status of the hospital, but the fact that you didn't think of it does not give you a free pass to get non-covered bills paid.