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

I'm preparing for my surgery, too, and was surprised when I got a check from Blue Cross for $216 with an explanation that it was for the anesthesiologist for my endoscopy.  The explanation also said that I would owe the anesthesiologist an additional $500+ because he was not a "preferred provider".  I checked my benefits brochure and found that they will pay something toward a non-preferred provider if the procedure is done in a preferred hospital (It was).  When I went to my surgeon a few days later, I asked if I could choose my anesthesiologist for my surgery.  He told me definitely not--the hospital has certain ones on staff and I'll get one of them.  Chances are good that I'll end up paying even more for the longer surgery.

I think I'm going to call the hospital to confirm what my doctor told me.  Also, when I get the bill from the anesthesiologist, I'll call his office to see if they'll accept less.

The bottom line is to check your benefits brochure.  If it says they won't pay or will only pay a portion, no state agency or anyone else will give you a different response.

I ran into a similar issue with anestesiologists for my birth epidurals.  The OB and the hospital are in-network, but the anesthesiologist group is out-of-network.  I had no choice as to who provided my pain management - at an in-network facility is is safe to assume that the providers who you have no say over ARE covered too.

I called insurance and told them I had no choice is who provided the epidural as I was at an in network facility and you get who you get for an anesthesiologist.

In the end it took lots of phone calls to insurance and the anesthesiologist office - but Insurance eventually paid the claim.

keep calling...keep fighting.  Do NOT pay an anesthesiology bill until insurance has issued you a new explanation of benefits that you are satisfied with.

Thank you so much.  Its a HUGE bill (actually its 2 different bills -but still a lot of $)  I am going to really hound the insurance company.  Its so sad that this happens.  I feel bad for those people who CAN'T SPEAK up for themselves! 

It helps to know I'm not alone!  I appreciate your comments!  Thanks so much

Insurance companies in this country are CRIMINAL. All that in and out of network crap is such BS. Guess this is a reminder that we should always get it in writing. So sorry. Good luck!

Most anesthesiologist are not in network. Why would they need to be? You will use their services regardless. I have never heard of an insurance company not allowing the anesthesia due to them being out of network because those types of services are beyond your control. Many insurance companies may deny your anesthesia claim until they can confirm that the facility and/or ordering doctor were in network, then they will usually adjust the claim. This usually needs to be prompted by a phone call from you though. Don't panic. Just call your insurance and see what happens. Tell them your surgery was approved and the doctor and facility were in network and you had no choice on who was used for anesthesia.

As for the doctor telling you everything is fine... First of all, MOST of the time, the anesthesiologist is not usually up to the surgeon. Usually those people are hospital based doctors and you get who ever is available that day. Most of the time the surgeon isn't going to know who is there that day. A doctor has to have contracts and rights to work at a hospital. You can't even go out and pick your own to come into the hospital to work unless they already have rights there. Too many legal issues and red tape. It's a liability issue.

ANYWAY, my point is this is extremely common and beyond almost everyone's control, but I would suspect the insurance should adjust your claim to pay as if they were in network. You could still be balance billed for any amount over what your insurance allows for the service, but that will be better than them just denying the whole claim.