Anesthesiologist is billing $3700 even though insurance is telling them to stop.

[u/JulesSherlock]

My husband went to the emergency room due to food blocking esophagus. He had to have a gastroenterologist, push it on down. The anesthesiologist billed his insurance who refused it based on it being filed too late. Procedure was 3/8 and they billed 7/1. Then they billed him $3700, which is when he noticed the issue. Said insurance paid $0 and if he didn’t pay by 9/15 it would go to collections. He called his insurance (United Healthcare - Medicare) and they said they would call them the next day and have them refile it. He watched for it online and saw that it had been re-filed on 8/1 so he thought it was ok. Well, insurance denied it again. It says denied due to filing too late and do not bill member. Same as last time. So he expects to get a bill in the mail any day now.

I feel like we’re going in circles. How do we get off this ride if we do get the bill again?

[u/Long-Raccoon2131]

First is the provider in network? If not they aren't obligated by a contract with the health plan to not bill. Also at the ER did you fill put forms one of which thet call patient responsibility form? That form ks a legal document stating you agree to pay anything not covered by insurance. Now is Medicare the only plan? Because if there is a primary policy and Medicare is secondary then primary deductible and out of pocket trump secondary billing

[u/Fin-Tech → u/Long-Raccoon2131]

What about the No Surprises Act? I'm thinking if the ER was in-network but the anesthesiologist wasn't, then the advantage plan is required to pay and the anesthesiologist is prohibited from balance billing under the NSA. Am I mistaken?

[u/Long-Raccoon2131 → u/Fin-Tech]

That ACT doesnt mean what many think it means. It means you cant be surprised with a bill ypu acknowledge and consented to. The No Surprises act is for when you cant make a decision and are air lifted or sent by ambulance to a non participating network hospital. If you went there yourself you signed cornet forms and patient responsibility forms.

[u/Fin-Tech → u/Long-Raccoon2131]

Below is an excerpt from: https://www.cms.gov/medical-bill-rights/know-your-rights/using-insurance#emergency-room-care

If your health insurance covers emergency care, you can't be charged any more for emergency medical services than the in-network “cost-sharing” rate by:

The hospital
The providers giving you care at the hospital
Your air ambulance provider (if you were taken to the hospital in an air ambulance)

<end excerpt>

OP's anesthesiologist was a "provider giving you care" and so the NSA would apply according to CMS.

Regarding your point about "can't make a decision," I would argue that a choking patient in the ER does not have effective agency to make any kind of "decision" (much less an informed one) about which anesthesiologist to use if there was even more than one option in the first place. I feel like this lack of transparency and agency is a foundational reason why the NSA was needed in the first place.