I got $2000 bill for anesthesia and insurance won't cover

[tsg2002cn]

What is the name of your state (only U.S. law)? Florida

Dear all,
I need you guys' help. 2 month ago I went to hospital for some surgery.
I got anesthesia before the surgery. Today I got the bill after processed by the insurance company. I need pay more than $2000 by myself.

The main problem is the anesthesia. The charges are:

$1600 from the hospital
and
$1500 from the anesthesioligist

The hopspital is in-network, and after $100 deductible, the insurance should cover 90%. However for the anesthesia, I was told the anesthesioligist is out-of-network, so the so-called usual & customary charge for anesthes is $700, and also they only cover 70% of it. Hence I need pay all the remaining, which is more than $2000.

Here I got 2 questions:

1. I chose the hospital because I know it is in-network. But how should I know whether an anesthesioligist who works in the hospital is in or out of network? Am I supposed to investigate the background of every doctor during my surgery? (actually I do not even know who will be in my team before I received it) I just do not think it is the patient's responsibiliy to know that kind of info when he got disease and needed medical help soon.

2. Even the anesthesioligist is out-of-network, the hospital is in-network,
so for that $1600 bill from the hospital, should the insurance pay as in-network? I do not know why they also only pay as out-of network.

I am just a student, and work part-time to make living. There is no way I can afford that $2000. I called both the hospital and insurance company, but I feel they won't listen. So can anyone offer me some suggestions what I should do?

Thanks for your help!

[ecmst12]

Your insurance paid the bill appropriately, it appears. Anesthesiologist are pretty much NEVER in network, there's no advantage to them for it. Unless your insurance has a policy to pay the anesthesiologist as in network regardless of actual network status, there's nothing you can do.

[thedoctorisin]

If anesthesiologists are almost never in network, then how can the insurance company claim that $700 is the usual and customary charge?

[lkc15507]

This is so common it's not even funny and unfortunately most folks have no clue what to do. You must use your appeal process with your insurance plan. Oftentimes there are provsions regarding no choice of provider that will allow these instances to be paid innet. Even if not, use your appeal process to demonstrate to the insurer that you had no innet option for both ancillary and primary coverage. It is the insurer's responsibility to provide you with a comprehensive network. I don't mean to imply you will be successful with the appeals process, but you must complete it prior to seeking redress in the legal system else you fight a losing battle in the courts from the get go. May be the charges aren't worth a legal battle, but they are worth a well thought out appeal. READ, KNOW, UNDERSTAND your plan document.
Best to you, lkc15507

Read when your plan allows out of area service as innet. IE choice of no innet provider, service not available innet, service provided incidental to travel, etc etc etc. Your plan doc will provide the basis of an appeal. You must give it a shot. I know most here do not like me and will dispute what I say, but I am sure that this appeal is "winnable". Emotion never wins, facts do. Once again, best to you, lkc15507