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/Sweet_Livin Apr 29 '25

That’s fundamentally incorrect. It could be a wrap network but that is usually considered in-network. Maybe more of a handshake agreement for OON rates? But That’s still not contractually binding.

But it doesn’t matter anyway. You’re arguing a hypothetical situation. You went to an in network provider, it (eventually) processed at the contracted rate. You have the amount that you need to pay. There’s no way to change it, that’s the agreement.

There’s no one to talk to about changing the rates. Obviously they can’t share the contract with you (honestly it probably wouldn’t illuminate much anyway). You can get all of your insurers rates for all of their codes at all of their providers on their website. It’s massive and hard to download/work with, but it’s out there if you feel like digging more

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u/BrierPatch4 Apr 29 '25

I'm just telling you what four different people in four different departments at my insurance company told me. That they have contract rates for IN & OON providers. Maybe it's because not all providers at this location are IN but they have a contract with the location itself?