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/juztforthelols1 Jan 26 '25

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”

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u/AluminumLinoleum Jan 27 '25

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.

-3

u/HuckleCat100K Jan 27 '25

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.

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u/Ill_Pressure5976 Jan 27 '25

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.

3

u/CitationNeededBadly Jan 27 '25

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.