Question:
I NEED you help with insurance issue!!!!!!!!!!!!!!

I am fighting a bill from the anesthesiologists that did my surgery. They billed me a WHOMPING $3571.00. My surgeon said it was a ridiculous amount and they should accept the $2,150 my insurance paid them. But no they want me to pay another $1,439.21. Please anyone that can send me info on what you paid either from self pay or thru insurance. THANKS my WLS friends. I need some ammo to fight with. Gail    — Gail O. (posted on August 13, 2004)

August 13, 2004
What does your insurance plan say? If the anesthesia group is contracted by your insurance company, they can't usually balance bill you; they should accept the contracted rate. If this group is out of your network, perhaps you are being billed at a non-network rate. At any rate, it sounds more like a mix up than something you need to be prepared to "fight" about. Call your customer service folks at the insurance company; they should be able to straighten this out for you. (FYI - what anyone else paid for anesthesia charges probably won't make any difference since contracts vary from plan to plan, region to region, state to state, etc.)
   — koogy

August 13, 2004
I would call your insurance company or look at your EOB was the 'anesologist' IN NETWORK? if so they HAVE to right off the 'balance' IF they were a non-network (and trust me you could have been in a in network hospital and 'got' a out of network anesologist... they 'can' bill for the difference. BUT I think it sucks!!! But be sure to find out if they were in/out. Then call the hospital and ask for 'patient relations' and COMPAIN to them ... sometimes they can get them to waive it ... Anesologists have it 'made' they sometime end up getting more the surgeon, and insurance companies dont ususally 'reduce' what they ask for. But the in/out is also a problem nation wide.... there were some that had this problem in our group; they ended up just 'paying' $ 1.00 a month... since they DIDNT even know that the aneolosist might be outof network and you have NO choice who you get... try this and see. Now if you were 'out of network' then your basically stuck.
   — star .

August 13, 2004
Most anesthesiologist will not contract wtih an insurance company. However, most will take the insurance payments as payment in full if you were in an in network hospital. You need to contact your insurance company and let them know that the anesthesiologist is balance billing and ask if they have that right. Rebecca
   — RebeccaP

August 15, 2004
Hi. I'm not sure how it all works but I was only billed $1500 and the insurance company paid it all. I think $3571 is rediculous. Good Luck!
   — AmyWollet

August 16, 2004
What I have discovered is that most anesthesiologist have opted to not join/belong to any "in network" insurance plans. In other words, we're caught between a rock and a hard place - you can't have surgery without them and they (for the most part) are guaranteeing that they get 100% of what they are billing since they are considered "out of network". They take insurance payments, but since they are out of network, as patients, we're responsible for the balance. My mother had surgery for cancer in Feb. and her anesthesiologist got paid only $500.00 less than the surgeon whose skills saved her life. The surgeon got $2300 as his "in network" negotiated fee and the anesthesiologist got about $1800 (only 500 paid by insurance, 1300 paid by my mother). Needless to say, I think the surgeon got screwed and if we're not careful, no dr. is going to want to be "in network". We (in general) don't want to pay higher insurance rates which, unfortunately, is the only way that the dr.'s will get paid a decent fee so now some are opting out of the insurance plans and we have to use them and pay the balance on our own. Don't get me wrong - I hate dr. bills as much as anyone, but look at your explanation of benefits and see how little they really get paid when they in turn have to pay their staff salaries, supplies, insurances, rent, utilities, etc. It isn't hardly worth their effort when they only collect $35-$40 for a 15 minute office visit.
   — Carolyn M.

August 18, 2004
In this instance, do this - call your insurance company, tell them what is going on. They should reprocess the claim due to the fact you have no choice of who your anesthesiologist is - basically it is whoever is on call that day. Kinda like when you have a baby. -Ang
   — Angela N.