Receiving bills from non-par providers (you didn't even know about!)

[gina1756]

What is the name of your state? FL

My daughter had outpatient surgery last October at the hospital. The hospital was participating with my insurance. Per my benefits, I am responsible for a $100 copayment only.

Labwork taken during the stay, unbeknownst to me, was sent to a non-participating Pathologist. I received a $220 bill from the Pathologist. My insurance paid $26.46 and the EOB I received actually states "Total Amount You Owe" $0.00". When I called the insurance company to find out if I'm responsible for the balance, I was told yes because the Pathologist is not participating. The EOB seems to contradict this. I filed an appeal but just received the denial in the mail today.

This is not the first time this situation has happened, nor will it be the last. I believe I should be responsible for the bill if I knowingly go to a non-par provider. But when I ensure the provider is par, and then they aren't responsible enough to ensure other billable parties involved aren't, then shouldn't they be responsible for the bill? At the very least, shouldn't the contracted agreement between the insurance company and provider ensure this doesn't happen to the member? I'm furious from all the money I already have to pay for health insurance and visits for my daughter, and then incompetent people cause me to senselessly pay more. I seriously think this should be a class action lawsuit.

[somarco]

When services are rendered you owe. Very few pathologists (and anesthesiologists, medical transport companies, radiologists, etc,) are in network. This means there are no agreements in place to limit what they can charge. Your carrier then reverts to R&C (reasonable & customary) and you are responsible for the balance. If penalties were assessed for out of network charges, you can usually get them waived.

You owe the money. Pay up.

[FLMommy]

I would contact the hospital.... we had somethign similar happen to us... although our daughter was inpatient.... everything from her labs to her catscan and MRI's were done my non-part. providers... HOWEVER, our insurance company decided to cover the expenses because the hospital she was admitted to was a participating provider and had contracts with the businesses that rendered services to our daughter, and yet were not PP. Not sure if it applies to you since it was out-patient, but it's worth a try.

[StarsMoon]

Originally Posted by gina1756

What is the name of your state? FL

My daughter had outpatient surgery last October at the hospital. The hospital was participating with my insurance. Per my benefits, I am responsible for a $100 copayment only.

Labwork taken during the stay, unbeknownst to me, was sent to a non-participating Pathologist. I received a $220 bill from the Pathologist. My insurance paid $26.46 and the EOB I received actually states "Total Amount You Owe" $0.00". When I called the insurance company to find out if I'm responsible for the balance, I was told yes because the Pathologist is not participating. The EOB seems to contradict this. I filed an appeal but just received the denial in the mail today.

This is not the first time this situation has happened, nor will it be the last. I believe I should be responsible for the bill if I knowingly go to a non-par provider. But when I ensure the provider is par, and then they aren't responsible enough to ensure other billable parties involved aren't, then shouldn't they be responsible for the bill? At the very least, shouldn't the contracted agreement between the insurance company and provider ensure this doesn't happen to the member? I'm furious from all the money I already have to pay for health insurance and visits for my daughter, and then incompetent people cause me to senselessly pay more. I seriously think this should be a class action lawsuit.

JMO.... I feel your pain, I too, just went through this same thing. Went had services done, then to find out that they sent tests to a second lab. Our insurance paid for the first lab but not the second one. There went a quick $105 bucks. And they didn't even offer the vasoline. I was so mad Needless to say, I had to pay
Sorry to hear bout your x-tra bill too.... this was in Fl. too. My second bill was sent to a lab in Tenn. Go figure....

[FLMommy]

I'm in FL too... I don't think it has anything to do with the state