out of network after the fact

suebaby · 08-26-2005, 08:53 AM

:cry
I had surgery with Dr. Spiegel July 28th, at the surgicenter

Received my explanation of benefits only to find out the surgicenter is out of network. No, I did not check on this before hand, but now am really stressing over the money it may cost. Called the surgicenter the referred me to their main office, she was not able to tell me how much it is going to cost me out of pocket, because they have not received the payment from UHC yet. HAS ANYONE EXPERIENCED THIS? AS, I said I KNOW I should have asked about this before hand, but it also seems like someone could have told me this at the surgicenter!?!?!?!?

piercedqt78 · 08-26-2005, 09:12 AM

Every policy is different, but I have a max out of pocket of $1500. I used an out of network surgeon but the hospital did the billing for him (as a package) and it was covered 100% but if he had billed seperatly I would have had to pay $1,500 total. I know because I called and ask the insurance company. There should ve something on the EOB that states provider may bill you $xxx is that not on there? Mandy

RayLandry · 08-26-2005, 10:17 AM

Sue,

How ironic! I am going through the exact same thing! I was banded on 8/9/05 and I just found out that the surgical center that I used was out-of-network. I assumed that since my surgeon was in network the surgical center was also. Man am I stressing! Assuming that UHC will pay 70%, thats still leaves me with 30%. Like I told my wife, what are they going to do? They can't have it if we don't have it! They'll have to accept some payments that we can afford and that is the bottom line. Well thanks for listening to me vent. Let me know what happens. Regardless. the surgery center and my surgeon are awesome. Good luck.

Ray
8/9/05
Dr. Snow
Fort Worth
280/259/180

suebaby · 08-26-2005, 11:06 AM

I hope they fix it too, IF not they may have Repossess

RayLandry · 08-26-2005, 12:51 PM

Reposses the band! LOL!!!! That is hilarious!

Can they do that?

Ray

suebaby · 08-26-2005, 01:10 PM

I cried yesterday today i am going to laugh

mousecrazy · 08-26-2005, 01:56 PM

I don't know if this helps, but my surgery center was out of network. When I asked about the insurance payment on it, they told me they would accept the in-network allowance, and not penalize me for it. Maybe this is the same for you. Good luck! Cindy

banded_for_life · 08-26-2005, 10:25 PM

That is what I was told as well Mouse. The Surgery Center of Richardson is an out of network hospital for UH, but Dr. Benavides is an in network doctor. But the sugery center in only going to charge me the in network price.

leatha_g · 08-27-2005, 06:35 PM

You're right, whoever got your approval should have educated you on the fact that the facility they use was out of network. My insurance said to me, if there were other facilities in the area that were 'in' network, they would not even pay out of network benefits. Hope this is not the case with you..

bubblesstina · 08-27-2005, 06:45 PM

hopefully you have out of network benefits. I also have UHC but have o out of network coverage. I am having a problem with the radiolgy department being out of network when I made sure I went to an in network facility!! Now they want me to pay 3000.00 for their services on my surg and my sons appendectomy 2 weeks prior to my banding!!

Flutterby2b · 08-27-2005, 08:01 PM

I was going to use The Surgery Center of Richardson, they told me they would accept what insurance paid and only bill me the 20% as was my in network rate. But they could not tell me if the 20% was of billed charges or of the reasonal and customary charges... There's a big difference in 20% of $27,000 and 20% of $7612.08. (actual allowed charges for surg.) I found another Dr who would do surg at an in network facility.

Loving my band and losing.

susu · 08-27-2005, 08:51 PM

I was banded by Dr. Spiegel on July 20. I also have UHC. If I am remembering correctly, the dr. office knew that the surgicenter was out of network and I would have to have it at the hospital. I knew this myself already because my husband was banded a year ago. I hope everything works out for you.

Good Luck!

MsButterKup23 · 08-28-2005, 04:42 PM

I used Dr. Powell who is in network for me. The Surgery Center of Richardson whould have ben out of network, so I ended up having mine at Renassiance (sp) Hospital instead.

I asked my insurance company before surgery if I used SCOR if there would be a problem and they said yes that they were out of network and I would have to pay the difference.

suebaby · 09-07-2005, 04:46 PM

Is the surgery center in Richardson part of the AIGB??

RayLandry · 09-07-2005, 04:59 PM

Yes it is Sue,

Ray