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/hbk314 Jan 26 '25

They already worked out a price: $50. They certainly can't expect to get paid more than that given the fraudulent way they coerced OP into proceeding with it. Confirming in writing it would be $50 while threatening OP with a $500 cancellation charge, then attempting to bill OP $20k is certainly not legal.

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u/Used_Map_7321 Jan 28 '25

The OP talked to the doctor office.  They make up whatever shit they want. Only the insurance can tell you your responsibility amount