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General Parenting
Out of Network Anesthesiologists
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<blockquote data-quote="bigblueagain" data-source="post: 4093" data-attributes="member: 909"><p>usually the insurance carriers will waive the out of network on anesthesiologists, as most of them( Anesthesiology groups) function such that they aren't in networks. Not sure exactly how they can do it, but suffice it to say they can and do. The hospitals know this, and if the hospital was in your network they should be allowing payment at the in network level(the anesthesiology group that is should be willing to take that level of pay as they know most hospitals are in networks....THEY are the ones who are choosing not to join the networks.) I would start with calling your insurance provider and asking for a customer service supervisor. Explain the situation and if they cannot resolve it for you, ask for the appeal process on claim payment. Would also go ahead and call the anesthiology group's business manager and tell them that you had no choice, you were at an in network facility that THEY chose not to participate with, and that you will not be able to pay more than your carrier covers. If you have an HMO product, they have to accept what your HMO pays when it gets right down to it. Many times they try this cause they know most lay people won't know how to fight them on it and will just pay!!!!Might also want to check your benefit booklet that should give you an page under which benefits payable to is listed. There should be a listing for hospital and surgical charges that should also include anesthesiology charges. Let me know how it goes! BLUE</p></blockquote><p></p>
[QUOTE="bigblueagain, post: 4093, member: 909"] usually the insurance carriers will waive the out of network on anesthesiologists, as most of them( Anesthesiology groups) function such that they aren't in networks. Not sure exactly how they can do it, but suffice it to say they can and do. The hospitals know this, and if the hospital was in your network they should be allowing payment at the in network level(the anesthesiology group that is should be willing to take that level of pay as they know most hospitals are in networks....THEY are the ones who are choosing not to join the networks.) I would start with calling your insurance provider and asking for a customer service supervisor. Explain the situation and if they cannot resolve it for you, ask for the appeal process on claim payment. Would also go ahead and call the anesthiology group's business manager and tell them that you had no choice, you were at an in network facility that THEY chose not to participate with, and that you will not be able to pay more than your carrier covers. If you have an HMO product, they have to accept what your HMO pays when it gets right down to it. Many times they try this cause they know most lay people won't know how to fight them on it and will just pay!!!!Might also want to check your benefit booklet that should give you an page under which benefits payable to is listed. There should be a listing for hospital and surgical charges that should also include anesthesiology charges. Let me know how it goes! BLUE [/QUOTE]
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