Health Insurance won't pay Anesthesiologist for C-Section

[francisco310]

What is the name of your state? California

My wife had to have an emergency C-Section and therefore had to use the Hospitals Anesthesiologist.

Now, 9 months later we are getting this bill in the mail for $2,645 for Anesthesia and/or Pain Management Services. The total amount was $2,880. Therefore the insurance ONLY paid $234.

The insurance claims, that the Anesthesiologist used is not under contract with them. In my view, we had no choice to use him, since he was the one on call at the time my wife had to have her C-Section.

Since, this is a necessary procedure, I don't see why the insurance would not be responsible for most of the cost. Try to have a C-Section without Anesthesia.

Help would be very much appreciated.

Thanks,
Francisco

 

[cbg]

This is unfortunately one of the problems with managed care as it currently exists.

The insurance carrier does not have the option of REQUIRING any doctor of any specialty to join their network. Therefore, it is entirely possible for a hospital to be in network and a staff member, such as an anesthesiologist, to be out of network.

Many members of both the anesthesia field and the emergency room field have chosen NOT to join insurance networks, since it is financially detrimental for them to do so.

In any case, what you have here is not a legal issue. It is a contractual issue. Nothing in the law requires your insurance carrier to pay for anesthesiologists in an emergency. Your insurance contract may or may not require such payment.

Your recourse is to use the appeals procedure in your insurance contract.