Additional Fees ?

I am curious to see if my experience is standard or a little suspect. I was almost ready to schedule surgery with a local doc and had gone thru the seminar, the visit’s to the psychologist and dietician etc. when my company was bought and our insurance changed. No problem, I have now identified a new doctor that is ‘in network’ for my PPO (actually EP) but the new doc is saying that I still have to pay $2500 out of pocket even though my new insurance covers 100% of the procedure. This is for additional services that are for the physician assistants etc. Does this sound normal or similar to anyone else’s experience?  I don’t mind the $2500 so much as paying for something that’s non standard, especially when my insurance pays 100%

If you are IN NETWORK your dr CANNOT balance bill you which means billing you for services above the contracted rate its part of there contract with your insurance company if they are out of network however they can charge you whatever they want and your insurance company will still only pay what they would have paid if you where in network... leaving you with whatevers left.... if he is in network i would first find another dr and explain that you have already gone thru the program they may just be willing to skip most of the proccess and or if you want to stay with this dr call your insurance company and let them now that this is happening because it shouldnt be allowed and your insurance company will or i guess ill say SHOULD deal with this for you. Oh yeah if all else fails call the department of insurance ** if they are in network and your insurance doesnt do anything about it**

There will be separate claims going to the insurance....one for the hospital, one for the surgeon, one for the anethesiologist.  Your benefits may be different for each thing.  Call your insurance company member services and ask them what your benefit is for each one. Keep asking questions until you understand how it works.  Tell the insurance person the amounts that the surgeon's office is telling you they will bill you, and get the insurance to explain to you why the doc can, or can't bill you for that amount. $2500 is probably your maximum out of pocket for professional services, the "100% covered" part is probably for the hospital's bill.