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

[u/Antique_Ad3823]

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.

[u/princesspeacock21]

It is the patient’s responsibility to confirm with their insurance if the providers and facilities are in or out of network, not the provider.

[u/MarkW995 → u/princesspeacock21]

This person is correct...There are many sub plans that insurance companies have...Sometimes a place takes the PPO option but not the HSA...

[u/AluminumLinoleum → u/princesspeacock21]

Not sure why you're getting down-voted; this is absolutely correct. Source: used to work for a medical insurance company. This is why you always call the insurance company and talk to a person to verify if providers are in network for big expenses. They have to document the call showing they told you it was in network, plus they usually send you a confirmation letter as well. It's the only way to cover your ass.

[u/throwaway_mog → u/AluminumLinoleum]

They’re getting downvoted because it’s a disgusting way for the system to operate. The consumer shouldn’t have to do a goddamn research paper with a bibliography every time they have a medical need.

[u/AluminumLinoleum → u/throwaway_mog]

Sharing correct and informative information should not be down-voted. It is information that helps to educate others on how to protect themselves in the current system.

The commenter isn't the one who made the system.

[u/juztforthelols1 → u/princesspeacock21]

If this is true it would be bullshit. Kinda before the FDA it was people’s responsibility to make sure the manufacturer didn’t ef up the drugs they were purchasing. Or how before OSHA it was like “oh you inhaled toxic fumes daily from this job and now you have cancer? Well you should’ve bought your own $3k gas mask and suit”

[u/AluminumLinoleum → u/juztforthelols1]

Of course it's true. It is the patient's responsibility to verify if a provider is in network. The patient has the billing responsibility, not the provider.

[u/HuckleCat100K → u/juztforthelols1]

You’re the one who’s full of shit. Your examples aren’t remotely comparable. It takes five minutes to go to your insurance’s website and check whether a provider or facility is in-network. Considering the minimal competency of so many medical office personnel these days, I would never trust what they say anyway. Half the time they are in-network and they are incapable of correctly billing it.

[u/Ill_Pressure5976 → u/HuckleCat100K]

This is bullshit. Insurance sites are rarely updated to reflect the reality of which docs are covered. Period. Health insurance companies commit illegal acts daily.

[u/CitationNeededBadly → u/HuckleCat100K]

Insurance websites are not necessarily up to date.  And a billing person at a doctor's office knows way more about the ins and outs of insurance plans and which billing codes their office uses than a random patient.

[u/Status-Image-9181 → u/princesspeacock21]

Then why do providers ask for insurance information, you simpleton? I hope being a class traitor was worth it.

[u/AluminumLinoleum → u/Status-Image-9181]

Because they want to get every penny they can from every patient, and they're more likely to get paid if a patient has insurance. Asking for insurance information doesn't mean they take on the responsibility to pay. That's still on you as the patient.

[u/No_Translator_5898 → u/princesspeacock21]

This should be part of the automod response! Would literally answer most questions posted here.

[u/FineRevolution9264 → u/princesspeacock21]

Corporate shill.

[u/sora312 → u/princesspeacock21]

Agreed. It’s falls on the patient in the end of the day to make sure that the facility is in network.