Out of Network Anesthesiologist Bill

Have you tried talking to your OB/GYN sometimes they can call the anesthesiologist and talk with them they should not use a out of network provider

We encountered a similar issue with BCBS about a year and a half ago. In our case, our DD was in the PICU, began projectile vomiting, and I pulled in a doctor who was passing in the hall to help. Turns out I was SUPPOSED to say, "excuse me, sir, are you in network? no? then could you please find us a doctor who is, while I stand here with my very sick daughter in obvious distress?" Don't get me started on this one!

We did get it resolved, after months of fighting. BCBS eventually paid the extra fees. Here's how we did it: follow Cheryl's suggestion and contact your HR rep. BCBS doesn't care about you as an individual. They DO care about keeping your employer as a client. So make your employer go to bat for you. The key to getting BCBS to pay the full claim is to establish that you had no reasonable choice in which doctor treated you--this is true in emergencies, and in cases where you are not given a choice of doctors. If they just pulled in an anesthesiologist who you've never seen before while you're in labor, you can make the argument that you were in no condition to choose or protest. That's the argument you need to make. If you were in a car wreck, and unconscious, and the ambulance just brought you to the nearest hospital to save your life, BCBS would pay for it even it they were out-of-network. Read your terms of coverage carefully (I know it's huge and a pain the patootie). You want to be able to cite the page where it says you can use out-of-network if there are no other available options. We had to lodge two separate written appeals, but it eventually got sorted, and we didn't have to pay. I know this is a terrible, stressful thing to go through. GL!

I work for a hospital and have helped people in this very situation. Call the hospital and tell them you are upset (be nice) and that you came to that hospital because that is where your doctor delivers and you had no choice in the matter - they can usually work with the group. THEY have the contract that keeps those Anesthesiologist working in that hospital. I hope that helps! Good-luck!

Coverage is determined by the employer NOT the insurance company. It's your company (or your spouse's) that you need to talk with as far as what is and what isn't covered. Contact the HR department. They're the people who can help in negotiating payment by the insurance company.

If you were in-network for everything except the anesthesiologist, then you have a case about not paying. Otherwise, if you are responsible, talk with the hospital as well as the doctor's office about a payment plan. They will work with you, especially if you are willing to pay. Some payment is better than no payment -- even for doctors. They have bills too.

Is this doctor out of network or in network? If he is out of network then he does not have to abide by any rate your insurance sets. If he is in network, then he is obligated to honor the contract rate with your insurance. If in network, simply send him a copy of your EOB (explanation of benefits) and the amount your insurance says you are responsible for. If out of network, then you really do not have much recourse, legally. You could try calling your OB/GYN or the hospital you delivered at. I'm assuming you did not choose your anesthesiologist (in the future, you do have the right to do so, by the way). So, you could argue that either the hospital or your OB/GYN should have notified you prior to the delivery that the anesthesiologist would be out of network. You could see if they would be willing to advocate your case for you with the anesthesiologist or you could try calling the doctor to see if he will work with you on the final amount. This is really an isurance issue more than an issue with the doctor, but I think you might have more luck with the doctor. However, you could call your insurance company and ask them to send you a copy of your policy outlining in detail your benefits. You might find that they did not honor your policy. In which case you could fight them. You are an on-going customer of BCBS and might have more clout with them b/c they don't want you to drop your policy. I said you might have more luck with talking to the doctor because doctors are generally more reasonable than insurance companies and he may be more willing to budge because he wants to get paid. Insurance companies very arbitrarily set low rates of what they are willing to pay. I know it sounds like an outrageous amount, but the doctor actually takes very little of that home. I think it's ludicrous that insurance companies have the power to determine what is "reasonable" to pay doctors for their services, but I won't get off on that tangent. I hope this is helpful and not just a bunch of rambling. You can send me a message if you need any more details on how to proceed, and I'll give you any information I have~ which isn't a whole lot.

I had something similar happen for a colonoscopy and basically if you are in an in-network hospital, with an in-network doctor, then there must not have been an in-network anesthesiologist and the insurance should cover it. I am not an insurance expert but that is how it was explained to me. If there was an in-network anesthesiologist available, that may change the situation, but doesn't make sense that the hospital would have done that to you.

Call your insurance company and ask for and advocate. They have to supply a person to help you through all the red tape of handling your insurance claims. This is a little known service, and I've never had to use one myself, but I've read about it.

Also, what anesthesiologist group is it? I know the one in Plano reduces the fee when you are out of network.

I know it's very frustrating!! Good luck!!

Hi S.,
I can definitely relate to this problem. I delivered both of my babies at Allen Presby and my insurance was with Unicare. My anesthesiologist both times was Allen Anesthesia Associates. The anesthesia bill was astronomical in both cases as it was out-of-network. Apparently anesthesiologists don't typically contract with insurance carriers so you almost always will get hit with the out-of-network claim. Of course the first step is to work with your insurance provider to get the claim processed as in-network since you didn't have a choice in the matter. This is the easy part as this is fairly common and the insurance provider will usually make an additional payment to the anesthesiologist at the in-net work rate. However, the kicker is what the insurance company considers to be "reasonable and customary". In my case (and yours it seems) this was significantly less than what the anesthesiologist charged. So you can fight with your insurance provider all you want but they will not budge because in every plan they include a clause for only paying what is reasonable and customary. They will say your only recourse is to go back to the doctor to get the payment reduced. Then the doctor will tell you to go back to the insurance company and it becomes a never ending cycle. What worked for me with my first pregnancy was to go to my HR rep and have her plea on my behalf directly with her contacts at Unicare. She was able to get my balance paid by Unicare. I think the HR department has a lot more clout than we do when negotiating with the insurance company. The second time I was not able to get support from the HR department so I let the bill go for almost a year. I was getting monthly invoices stating that the balance was about to be turned over to collections. And then suddenly one month I got an invoice where almost all but about $200 had been "written off" so I promptly paid the balance and never heard from them again. It sounds like you have gotten as far as you can go with both your insurance and the doctor. I would suggest next going to your HR rep and explaining how upset you are and seeing if there is anything they can do on your behalf to have the insurance company pay more. If that fails then honestly I would ignore the bill. If they do eventually send it to collections then you can work out a payment plan at that time. It took me over a year to get it all resolved with both pregnancies and definitely put a damper on being a new mom. I know how stressful and frustrating it is. Good luck and don't give up yet! Sorry this is so long but it is a pet peeve of mine! :)

yes-- to keep it from collections pay 5-10$ per month-- if it goes to collections they are a little rougher on you to get THERE $ keep calling the doctor's business office and see if it can be lowered any more since the dr. was out-of network and the hospital was in-network also see if the insurance co. can pay any more too...

I had that EXACT same issue when I had my son. The anesthesiologist that was on-call at the hospital I was delivering at, for some reason, wasn't contracted with my insurance so the bill that I received from him was astronomical. Like you, I had to send him a letter asking to reduce the bill, but my argument was that I was not given informed choice. Had I known that the possibility was there that the doc that the hospital had on-call was no contracted with my insurance, I may have been able to choose a different route or ensure that a doctor that WAS contracted be used. However, at the time of labor is NOT the time that I should be confronted with that choice as I'm in a great amount of pain and it would have caused me great distress to learn this. All of this was out of my hands. I asked that I be allowed to pay the cost of what it would have equalled to had he been contracted with my insurance. At this point, it's been a year and a half since that letter was sent and the last time I spoke with the doc's office, it was still being considered. So either it was forgiven in total or it is STILL being reviewed. I don't know if you delivered in a hospital and he was the on-call doc so you didn't really have a choice, but - at the very least - the hospital can assume some responsibility for using a doctor that isn't contracted with the same insurances that they are. That has to come up on a regular basis, I would think...

Hope this helps!