medical billing

[healthnut]

I went to a g-i doctor for a colonoscopy. After meeting the doctor, for the first time, he explained the procedure. Gave me a choice of having the procedure in his office or hospital. Since I chose the office, he informed me that insurance will not pay for anesthesia in the office. And that my out of pocket cost would be $150, payable to the anesthesiolist prior to entering the operating room. Now, 5 months later the anesthesiologist attempted to collect $900 from my insurance company. The claim was denied. She is now billing me. I was not told that the $150 was a deposit or partial payment. What is my responsibility? This occured in New York State.

 

[ALawyer]

Find out what the insurance company would have paid the doctor if the anesthesia services had been rendered in the hospital. That's all you should have to pay as that suggests his or her "reasonable and customary" charges. The $900 is the "rack rate" that insurers always cut down. And complain to your doctor and the insurance company too; what's the difference in or out of the hospital?

And next time avoid the anesthesia -- I know lots of folks who do on that procedure.