Hospital used out of network healthcare providers
Had a surgery at one of El Camino Health hospitals in Las Gatos. My doctor who performed the surgery and the hospital itself was in-network for my insurance which I verified before the procedure but some of the ancillary providers like anesthesiologist etc during the surgery were out of network and my insurance (Cigna) refuses to negotiate these charges or contribute anything meaningful to the charge. I am left holding the bag for these charges. Not exorbitant to bankrupt me but somewhere of the order of $10K. Anyone else been in this situation? What did you do? What are my alternatives?
Consult an attorney
Choose Kaiser if possible. No such headaches.. If the hospital and doctor are in network, how come others are out of network.. US health care is a big mess..
Very common practice and I haven't seen a good way out that worked for anyone. Let us know if you figure out how to get out of it
Is it our responsibility to check if the 3-4 supporting doctors are also in network?
Supporting doctors are not finalized till day of procedure. If you ask on morning of surgery about insurance status and you decide to not proceed, you can cancel the surgery. There is always the chance of last minute reschedule or needing another set of hands during the procedure that's a medical necessity and that you can't avoid. It sucks and if someone figures out a fix for this, please let us know.
California (where OP is) has some protections against things like these. A hasty search turned up stuff like https://www.insurance.ca.gov/01-consumers/110-health/60-resources/NoSupriseBills.cfm Hopefully federal rules will arrive soon https://www.hhs.gov/about/news/2021/07/01/hhs-announces-rule-to-protect-consumers-from-surprise-medical-bills.html
Such basic rules should already exist, it's crazy how the US doesn't have any protections against such bs. I mean as it is you need to check for in-network hospitals and even after that you need to check where each person who's part of your medical procedure is from. Just crazy And sounds so much like a scam
Interesting, but note it says it doesn't apply to self insured plans, which outside of kaiser, is likely to be the plan you have if your company is more than 500 ppl. Possibly you can complain to apple, through the apple benefits rep, since they are ultimately paying the bill.
Welcome to America
When you have not chosen out of network providers, you can appeal. In many cases hospitals end up dropping charges. Don’t give up, talk to Cigna and keep asking for managers and explain. They may be able to help. Tell them why do they contract with hospitals that cannot provide in network anesthesiologists. It is their fault for not making it known to members.
For whatever it’s worth you can search legislation on surprise medical bills- I believe the feds just outlawed the exact practice you’re talking about. I work in hospital consulting and we deal with these kinds of OON bills pretty frequently (to get the insurance to pay rather than the patient)
Sue the hospital for not telling you that they were using out of network providers.
I am sure they can get me on the technicality that I asked “are you in network” vs “are all your providers in-network”
@apple let the lawyer handles the technicality, not you