r/HospitalBills • u/BrierPatch4 • Apr 28 '25

Hospital-Non Emergency In-network is more?

I feel like I'm going crazy here. Explaining is too long, let me sum up.

Husband went to two appointments with new provider. We checked before, was listed on our insurance portal as in-network. When I got EOB, processed as OON. Called insurance (three times) & finally got them to reprocess as in-network. Just got new EOB's & now we owe $650 more than the out-of-network cost.

I have spent an hour on the phone today between insurance & the clinic. Both are saying I need to speak with the other. Do I just escalate this or is there a specific department I need to ask for?

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u/BrierPatch4 Apr 28 '25 edited Apr 28 '25

Update: I've been on the phone another hour+ with insurance & provider. Everyone agrees this is crazy & they've never seen this happen before. No one knows what to do, just referring me to the other one.

I'm also currently researching how to file a grievance with my state.

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u/elsisamples Apr 28 '25

Something is going sideways with claims processing. Get a reference number for every call and detailed EOBs for both scenarios.

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u/BrierPatch4 Apr 28 '25

I have ref #s & names for every person I talk to. & All OON & IN EOB's are printed.

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u/elsisamples Apr 28 '25

If you wouldn’t mind sharing with personal info blacked out via PM. I’m curious now.