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Wife had a baby in July. We used in network doctors and hospitals. Our health insurance Highmark and Allegheny Health Systems have a close partnership. Every commercial on tv mention both names.

Two months later we get a bill in the mail for the newborn hearing test for $220. It not a ton of money but I call the insurance to find out why. They say the company who conducted the hearing screening is out of network and they are sending us a check for $50 which covers their out of network obgliation.

I finally get a hold of the provider who billed us, Pediatrix. Appearently they are a nation chain who provide 3rd party services and were contracted by the hospital. Billing office in Florida, customer service in Virginia.

Now why would a health system contract with a provider who does not take their primary insurance partner. This service was provided while the wife was admitted as a in-patient. I cannot recall ever being notified about this 3rd party service. Every review of this company online has complaints they out of network for most insurances.

The more I look into this It appears to be legal in PA. Some states have passed laws preventing this practice. I have read horror stories where people have been unconscious and need emergency treatment where taken to in network hospitals but the on call surgeon is out of network and they have 50k plus medical bills.


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Posts: 3878 | Location: Pittsburgh, PA, USA | Registered: February 27, 2001Reply With QuoteReport This Post
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Yep this is legal. The insurance company is very well aware of it. It is all about the money. There has been some governmental intervention. For example you are having chest pain and go to a facility that is in network. You then get a hefty bill from the ER physician who is out of network. In most cases that bill will be covered by your insurance.

If you want to invest the time, I would call the Hospital Administrator and also contact your State Insurance Commissioner.

Good luck.
 
Posts: 4051 | Location: MS GULF COAST | Registered: January 02, 2015Reply With QuoteReport This Post
I have not yet begun
to procrastinate
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Oh, balance billing. What a JOY!
Having 5 surgeries in the last 2 years on the 2 people in this house, balance billing is such a nice surprise...it's almost like an early Christmas only you're on the naughty list and get crappy "presents".

Why do a hearing test on a newborn anyway?
Is there a malady that can only be cured in the first 24 hours and is permanent if not caught RIGHT THEN?
As long as hearing is addressed at their first doctor visit they should be good to go based on the info I read.


--------
After the game, the King and the pawn go into the same box.
 
Posts: 2942 | Location: AZ - West side of the valley | Registered: October 26, 2006Reply With QuoteReport This Post
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Picture of V-Tail
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quote:
Originally posted by KMitch200:

Why do a hearing test on a newborn anyway?
I was wondering this myself.

General question: Does the patient (parents, in this case) have any control at all, over what tests are performed? Or is the hospital free to perform or order anything that they want to, and then bill the patient?



A mind is a terrible thing.
 
Posts: 19137 | Location: Central Florida (near Orlando) | Registered: January 03, 2010Reply With QuoteReport This Post
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quote:
Originally posted by V-Tail:
quote:
Originally posted by KMitch200:

Why do a hearing test on a newborn anyway?
I was wondering this myself.

General question: Does the patient (parents, in this case) have any control at all, over what tests are performed? Or is the hospital free to perform or order anything that they want to, and then bill the patient?


Per this website, doesn't look like they can force you to do it in PA.

http://www.ncsl.org/research/h...ning-state-laws.aspx

They know they have you over a barrel right after you have given birth though. Most people wouldn't challenge anything at that point.
 
Posts: 960 | Registered: July 06, 2016Reply With QuoteReport This Post
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Picture of m1009
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I would contact th hospital and fight the bill, since they are the ones who sent to the Florida based company without either checking for a contracted plan for you, or informing you of the test and that the place wasn’t covered under your insurance. Or, call your insurance and let them know too. But, hospital should either write off the bill, or adjust the balance to what would have been your cost, if any, in my opinion.
 
Posts: 597 | Registered: September 27, 2008Reply With QuoteReport This Post
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You've got nothing to lose by bitching.
 
Posts: 14307 | Location: Lexington, KY | Registered: October 15, 2006Reply With QuoteReport This Post
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From the article referenced by Palm, above
quote:
In the second paragraph:

Screening programs are typically cost-effective and amount to about $10-$50 per baby, according to NCHAM.
I do not play nicely with stuff like this. If it had happened to me, my stance would be, "you are charging $220 for a screening that typically costs $10 to $50. You have already been paid $50. Kindly pound sand."

I have aggravated more than one medical practice by refusing to sign authorization for a procedure until they tell me, in writing, what the total cost is, what is covered by my insurance, and what my maximum co-pay will be. I'm going around and around with this right now, with a doctor who wants to perform a procedure. His scheduling person is bugging me to set an appointment; I told her that there will be no further discussion of scheduling this until my questions about cost are answered. Fortunately for me, there is no medical reason to have this done quickly, so time is on my side.



A mind is a terrible thing.
 
Posts: 19137 | Location: Central Florida (near Orlando) | Registered: January 03, 2010Reply With QuoteReport This Post
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I would/did not question the hearing test. The hospital made it sound like it a routine test and done on every newborn. I have top notch insurance with no deductibles (in-network). I was at an in-network hospital everything is covered. Test away.


I spoke with the hospital billing dept. and they said my account has a zero balance. She explained the 3rd party company bills directly so she would not see any balance on her end.


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Posts: 3878 | Location: Pittsburgh, PA, USA | Registered: February 27, 2001Reply With QuoteReport This Post
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Sorry to hear about that. You may also want to talk to hospital administration and ask about the charges and how are you supposed to know if something is covered by your primary network or not.

In 2012 I was in the hospital for unknown infectious disease. They assigned me an infectious disease specialist who was in my primary network but she sent a whole lot of blood work to a different hospital that was not in my primary network and the bill we got was several thousand dollars instead of a few hundred. I complained to hospital and doctor and they took care of it but I learned a lesson. Just recently i went to my dermatologist and he did a biopsy and the lab he sent the biopsy too was not in my primary network and I was zinged for $146 instead of the $15 I would have normally paid because second tier providers have a higher deductible than primary in our plan. Now I eventually got to find a dermatologist who uses a lab in my primary network. It is best to always confirm any lab work, surgery, diagnostics, especially MRi/MRA/CT/anything expensive, is done by providers in primary network. Outpatient diagnostic imaging and other expensive procedures also often require pre approval to be covered by insurance.

I hope you get it worked out and if nothing else you learned a fairly valuable lesson for not a whole lot of money.


“When the people find that they can vote themselves money that will herald the end of the republic.”
― Benjamin Franklin
"The problem with socialism is that eventually you run out of other people's money."
― Margaret Thatcher
 
Posts: 8565 | Location: Northern Illinois | Registered: March 20, 2009Reply With QuoteReport This Post
Fighting the good fight
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I got smacked by this when I had my knee surgery a decade ago. My surgeon and the hospital were in network, but the anesthesiologist they utilized was not, for some reason.

Expensive lesson. It was my first major medical procedure, and I just assumed (Roll Eyes) that if the doctor and hospital were in network, it was all good. I was never given a choice of anesthesiologists, and it never occurred to me to check if that portion was in-network.
 
Posts: 21621 | Location: Northwest Arkansas | Registered: January 06, 2008Reply With QuoteReport This Post
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Daughter (16 yrs old) was kayaking during a camp outing. Rolled and cut her chin, enough the counselor figured a trip to the ER was a good idea.

Long story short. Three stitches. Hospital in network. Doctor, not.

Total bill was nearly $3,000. Out of pocket nearly $1,500

Three stitches


-.---.----.. -.---.----.. -.---.----..
If they don’t keep exercising their lips, he thought, their brains start working.
 
Posts: 4124 | Location: Tampa | Registered: August 19, 2007Reply With QuoteReport This Post
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i had a few tests in 2018 (MRI, CT, Bone density, colonoscopy, blood work, blood work, and more blood work) and I'm still getting bills from individual doctors, testing labs, other companies, different hospital / medical groups.

It's all bullshit, and I hate it so much. Trying to file for financial assistance or fight both a hospital and/or insurance company over a bill is made to be nigh impossible just to make it so frustrating that we give up and pay it or to take so long that it goes to collections.


☣Biohazard☣
 
Posts: 7043 | Location: Alpine, Ut | Registered: February 17, 2010Reply With QuoteReport This Post
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I am going through the same situation as you at this time with Cigna. I had surgery done last month. I made sure I had it done at an In-Network hospital. When I had my ENT appointment, I made sure that the ENT doc (which was also my surgeon) was also In-Network. However, I already have a feeling that there will be someone involved with the surgery team that is NOT an In-Network provider. Sure enough, I received a letter from Cigna informing me that I "MAY" receive a bill from a Neuro Monitoring Company that is an Out-of-Network provider.

Cigna already wrote them a letter informing them the usual and customary charge allowed for the same service for an In-Network provider. They offered to pay them that amount. I expect to still pay 20% co-pay (my responsibility). I was instructed by Cigna to let them know if I receive a bill that is MORE than what is shown in my EOB, which is my In-Network co-pay.

I am waiting to receive my bill from the Out-of-Network provider to see if they will accept what Cigna offered. If not, I will have to contact Cigna and let them negotiate that bill. In the end, I expect NOT to pay more than what I have to.


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Posts: 1295 | Location: Las Vegas | Registered: November 05, 2003Reply With QuoteReport This Post
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My medical coverage is thru Aetna and my Pennsylvania State Employees Retirement program.

The PA Retirement program and Aetna covers the 20% that Medicare does not and fronts for Medicare.

Aetna also makes damn sure my medical needs are within the "In network" coverage.


*********
"Avoid the rush and Procrastinate now".
 
Posts: 6249 | Location: Arizona | Registered: August 17, 2008Reply With QuoteReport This Post
His Royal Hiney
Picture of Rey HRH
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quote:
Originally posted by RogueJSK:
I got smacked by this when I had my knee surgery a decade ago. My surgeon and the hospital were in network, but the anesthesiologist they utilized was not, for some reason.

Expensive lesson. It was my first major medical procedure, and I just assumed (Roll Eyes) that if the doctor and hospital were in network, it was all good. I was never given a choice of anesthesiologists, and it never occurred to me to check if that portion was in-network.


I don’t know about this; not that I don’t believe you. Are you supposed to be like the general contractor for your operation?

If I arrange with an in-network hospital and surgeon, I think it’s on their people to make sure everything else is covered by the insurance.



"It did not really matter what we expected from life, but rather what life expected from us. We needed to stop asking about the meaning of life, and instead to think of ourselves as those who were being questioned by life – daily and hourly. Our answer must consist not in talk and meditation, but in right action and in right conduct. Life ultimately means taking the responsibility to find the right answer to its problems and to fulfill the tasks which it constantly sets for each individual." Viktor Frankl, Man's Search for Meaning, 1946.
 
Posts: 15062 | Location: Bay Area, CA | Registered: March 24, 2011Reply With QuoteReport This Post
thin skin can't win
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quote:
Originally posted by Rey HRH:
quote:
Originally posted by RogueJSK:
I got smacked by this when I had my knee surgery a decade ago. My surgeon and the hospital were in network, but the anesthesiologist they utilized was not, for some reason.

Expensive lesson. It was my first major medical proce dure, and I just assumed (Roll Eyes) that if the doctor and hospital were in network, it was all good. I was never given a choice of anesthesiologists, and it never occurred to me to check if that portion was in-network.


I don’t know about this; not that I don’t believe you. Are you supposed to be like the general contractor for your operation?

If I arrange with an in-network hospital and surgeon, I think it’s on their people to make sure everything else is covered by the insurance.


Agreed and you’re right. Well right up to when you sign that acknowledgment of responsibility at admit. There are a lot of words there but it likely includes agreement to pay any in and out of network charges of ancillary providers.

Protesting this to top levels of hospital admin can sometimes bring pressure to relief.



You only have integrity once. - imprezaguy02

 
Posts: 8981 | Location: Madison, MS | Registered: December 10, 2007Reply With QuoteReport This Post
Shit don't
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posted Hide Post
quote:
Originally posted by Rey HRH:
quote:
Originally posted by RogueJSK:
I got smacked by this when I had my knee surgery a decade ago. My surgeon and the hospital were in network, but the anesthesiologist they utilized was not, for some reason.

Expensive lesson. It was my first major medical procedure, and I just assumed (Roll Eyes) that if the doctor and hospital were in network, it was all good. I was never given a choice of anesthesiologists, and it never occurred to me to check if that portion was in-network.


I don’t know about this; not that I don’t believe you. Are you supposed to be like the general contractor for your operation?

If I arrange with an in-network hospital and surgeon, I think it’s on their people to make sure everything else is covered by the insurance.


Complete and utter bullshit what they did to you. Are you supposed to ask for a "show of hands" who's in network? Then, when the anesthesiologist says no, are you supposed to call the whole thing off? Mad
 
Posts: 4439 | Location: 7400 feet in Conifer CO | Registered: November 14, 2006Reply With QuoteReport This Post
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In a number of states Medicaid does not cover anesthesia for kids undergoing dental procedures. The parent must foot the bill. Parents are told in advance.
 
Posts: 4051 | Location: MS GULF COAST | Registered: January 02, 2015Reply With QuoteReport This Post
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