Surgery was APPROVED but now will not pay for anesthesia ~ !

We set aside what we knew we would need financially to cover our out of pocket expenses for the surgery.  I double and triple checked that all of my ducks were in a row (from the insurance stand point).  Made sure my surgeon AND the hospital were BOTH in my network.  Knew exactly what we would be responsible for financially.   I just found out that the Anesthesia portion of the bill will not be covered at ALL because that doctor was 'out of network'.   I had absolutely ZERO say so on WHO my anesthesiologist would be.  I spoke with the insurance billing person at the Surgeons office MULTIPLE times before surgery to let her know that if it was not a covered procedure,  I could not afford to proceed.  I was assured that it would "all be fine, we already have your pre approval".

Has anyone else experienced this?  What did you do and what were the results?  Thanks so much!  

First don't panic it is probably just a mistake somewhere. They will probably let you make payments but I would certainly make sure the surgeon knows about all this. They should make sure the people in their team are also in the same insurance networks that they work with. Make a whole lot of noise about this but in the end I think you are still responsible for the final debt. I hope I'm wrong but I have ended up having to pay some bills to assistants because they weren't in network. Good luck!

Call the billing person who told you it would be fine and explain what has happened. See if she can do anything. Also call the anestjesiolohist' billing dept and ask what you can do re: the bill. They may be willing to work out a payment plan or deal with your insurance company & try to get them to cover it (or part of it) for you. 

Call the surgeon's office and speak to the billing coordinator. Let him/her know what you've found about the specific anesthesiologist and see what he/she can do. If they can't do anything, which I doubt, they can help you figure out what you need to ask your insurance company.

Please keep us informed as to how this gets resolved.  I would be willing to bet it will get worked out; there are probably several anaesthesiologists on staff, and some in your network.

(And if it's not too private, can you tell us about what the anaesthesia bill will be?)

Hi, 

i have some serious "on the phone" time ahead of me to work on getting this resolved. There were two bills and they total $3000.  

I knew I'd get a separate bill in he mail for anesthesia, but was not expecting 1400 bucks. I'm screwed.... 

I knew I would have to pay for mine because the whole surgery was self pay and mine was $1500 so that sounds about right. I only have to pay $50 a month so that isn't too bad.

Do not call the surgeon's office-this is an issue for the insurance company and anesthesia group. The claim probably just needs to be reprocessed--speak to your customer service dept at the insurance company and point out the approval and other claims paid for same date of service. If they give you a hard time file an appeal and send complaint to your state's insurance commissioner (you can likely do this online)…that should take care of things. this is not an unusual occurrence, just needs someone to take some extra time looking at the claim. 

Thanks so much.  I didn't realize there WAS a "state insurance commissioner'.  I will definitely look into finding contact information for them.  It wouldn't be so upsetting, but I verified EVERYTHING else was in our network in advance.  I wasn't given ANY options for the anesthesia group, and just assumed that since BOTH the surgeon AND the hospital were in network, they KNEW who my insurance would/would not cover.  

Very helpful.  Thank you!