My dilemma concerns “surprise billing.” Serious answers only, please. Desperately need some advice.
Before I say anything, I cannot emphasize enough how thankful I am that this is only $2,500 whereas many other Americans have emergency hospitalization and surgery that takes them way into the five digit range.
I break my wrist in October and it requires surgery. I know my HDHP’s deductible and OOP max. I believe I was just short of the OOP max before my initial ER visit but had definitely met my deductible. Either way, to find an orthopedic surgeon, I use the health system’s website to “find a provider.” Mind you the physicians listed are all “health system owned” and since I am an employee of the health system, this would be a tier 1 physician. We find the surgeon and her address and phone number. We schedule an appointment at the outpatient orthopedic office which then leads us to surgery at an outpatient surgical facility. Things go as normal and I’m in a cast for 3 weeks (metal plates instead of pins and a hard cast).
A month later I receive a bill from a facility I’m not familiar with but the name gives it away as orthopedic -related. It’s a bill for $2000. I also get an EOB and it shows that overall the surgery cost about $26,000. The health system-owned physician’s charges are covered 100% (expected because I know my insurance and whatnot!). Luckily my insurance covered $24k of the $26k charged by the OP facility and I am left to pay what my insurance did not. Like I previously stated, I understand $2k is decently manageable and it could be WAY worse but considering I have already paid close to $5k out of pocket for the entire year, I found it surprising.
A call to the claims company told me that the OP facility is tier 2. This is where my problem is and where I believe I have some ammo. I used the website. I find an owner provider. “Okay, cool” I think, all should be grand. How in the world can they list a tier 1 provider with a tier 2 address!? I would have NEVER chose her if I had known this.
In all honesty, I’m not looking for the bill to be erased. I understand having to fork over a few hundred. Mind you I also have a $500 bill from the anesthesiologist which was likely tier 2 as well.
TL;DR Trying to appeal the charges not covered by insurance because the facility was tier 2 (as opposed to the ortho surgeon I found on my hospital systems website being tier 1).
Who do I contact first? Do I call and/or write? Tips? Things to remember? Anything is helpful!
0 nhận xét:
Đăng nhận xét