Insurance

[jchipka]

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

My insurance is refusing to pay other than out of network for anesthesiologist. There is no anesthesiologist within 50 miles of my hospital and doctor. Now insurance is saying I must pay this bill and they only paid a portion of it.

[cbg]

And they are correct.

[ecmst12]

Well, as long as they paid the bill correctly according to how the policy is written, you have to pay the rest.

[lkc15507]

You know, I 100% agree with the answers above. However, I would not lie down for that. Correct or not by the letter of the plan, there is room to appeal here. Will you win? Who knows. I would try. I would look at my plan regarding any out of network allowances. Does the plan allow ANY out of network situations as in network? The plans I work for have language with regard to when the participant has no choice of provider. Certainly not all plans do. But, then I would challenge them on the basis of the availabillity of a network provider. REASONABLE. How far is it reasonable for someone to travel for routine care? That type of stuff. Read every word of your plan doc. The Plan has a responsibility to provide you with network providers. Best to you, lkc15507

[lkc15507]

And, anesthesiology is a perfect example of no choice. If you were at a network facility, utilizing network surgeon......we all don't getta choice of anesthesiologists. Not under our control.

[justalayman]

Originally Posted by lkc15507

And, anesthesiology is a perfect example of no choice. If you were at a network facility, utilizing network surgeon......we all don't getta choice of anesthesiologists. Not under our control.

actually not true. You can choose or refuse. In my wife's situation, she requested a specific anesth. ,I believe, for 4 surgeries and was granted the accommodation. When she initially asked, the said we don't have a choice and my wife politely informed them we do have a choice;

the anesth. she chose or go elsewhere.. They provided the anesth. she chose.

[lkc15507]

Okay, I guess you are suggesting that applies without exception. Of course it is possible that some may be accommodated. Please don't imply that it is the norm because it is not.

[justalayman]

it is as simple as this;

when I have a procedure done, I make sure that all entities are within my network and if they are not, I inform whomever that the provider must be within my network. If a network provider is not available in such a situation, I contact my insurance company and request their direction.

it is the norm whenever I have a medical procedure done and due to the extreme difference in costs to a person dealing with in or out of network providers, it surely should be the norm. If a patient fails to do this, it is their fault.

why do you believe it so difficult to determine whether all parties are within a persons network or to demand that all providers be within network. I have never been refused although they may not like it, they do it. It is surely my right.