r/HealthInsurance • u/Antique_Ad3823 • Jan 26 '25

Employer/COBRA Insurance $20K colonoscopy, when dr’s billing office said $50 in email?

Had a colonoscopy by an in-network doctor, at their own surgery center. Before the procedure I spoke with the doctor and billing office to make sure it was all in-network. They confirmed in writing via email, explicitly said I’d only be responsible for my $50 co-pay, with no out-of-network charges.

Weeks after I get 2 denial EOB letters from my insurance, saying the surgery center and anesthesiologist are out of network, and I’ll owe $20K. After some googling it looks like the surgery center and anesthesiologist aren’t in-network with any insurance!

What is happening? Will the doctor’s office really come after me for $20K, when in writing they said I’d only be billed for $50? If so, what can I do? I’m not sure if No Surprises Act will cover this.

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u/SevoIsoDes Jan 26 '25

This is the exact scenario the No Surprises Act is meant to address. As this wasn’t emergent, they had a responsibility to give you a cost estimate prior to the procedure. Don’t pay the bill. Tell them to work it out with your insurance company for fair payment.

13

u/ehenn12 Jan 26 '25

They can also file a complaint with the federal no surprises help desk, which will force the providers to settle with the carrier.

6

u/icelandisaverb Jan 26 '25

Yep! My husband had a very similar situation after an ankle surgery (hospital told both us and the surgeon that they were in-network on our plan, insurance informed us after the surgery that the hospital was actually out-of-network). They tried to stick us with a $35,000 bill, but it eventually was dropped since the hospital never informed us at any point that they were out-of-network (and had actively misled us into thinking they were in-network). We reached out to our state's DOI for assistance, but the issue was resolved before they could get involved. I still don't know if our insurance just decided to cover it, or if the hospital wrote it off-- one day the balance owed magically dropped to $0.00.

It's insane that we're okay with a medical system full of "gotchas", though, especially as many people are already navigating highly stressful medical issues. I'm glad that the No Surprises Act is attempting to address some of this.

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u/Chase_London Jan 26 '25

this is the correct answer. doctors and hospitals are little shit heads. don't pay them, punish them. i would also sick my insurance company on them. they have even more resources to help hold shady providers accountable.