Sibley epidural cost from anesthesiology

[Anonymous]

Hello, we have CareFirst insurance and recently delivered at Sibley. To our surprise, the anesthesiology group, Certified Anesthesia Services (which is apparently the only anesthesiology group at Sibley) does not take our insurance and sent a bill for $6000. Can anyone advise the best way to handle this? So many families have CareFirst in this area, I am sure I'm not the first one with this issue. Thank you!

[Anonymous]

That seems like a billing error. If the doctor and hospital both take your insurance carrier the anesthesia group should have too as well.

[Anonymous]

Something similar happened with us and BCBS at Sibley with my epidural. Called insurance, they took care of it with the billing department.

[Anonymous]

Anonymous wrote:That seems like a billing error. If the doctor and hospital both take your insurance carrier the anesthesia group should have too as well.

This. Also have carefirst, delivered at Sibley, and it was covered.

[Anonymous]

The anesthesiology practice could well be out-of-network .... the No Surprises Act, which comes into effect 1/1/22, is designed to address this problem.

In the meantime, your insurer may go to bat for you -- they can negotiate with the out-of-network provider. If you don't get much traction with the insurer, see if your employer can put pressure on the plan to work this out -- the employer is the insurance plan's real client and may have more juice.

[Anonymous]

I successfully fought a bill like this years ago, but I had called the surgical center first for my outpatient surgery to inquire who the anesthesiologist would be ahead of time to confirm they were in network and was told it was whomever would be assigned but that they were all in network. I documented the call including the name of the staff person, date and time so when I had the bill to fight months later that helped me out a lot.

I also fought a similar bill and successfully won for the audiologist at GW who performed a required newborn hearing screen but was out of network and charged me like 900 for a legally required test. My BCBS plan fought that claim for me and I ended up winning.

As a patient at an in network hospital with in network doctors you don’t get to choose your anesthesiologist so your insurer may be willing to help you fight this. But unfortunately it usually takes a lot of time. My first and best tip is to document everything and everyone you speak to. First call is to hospital billing to get clarify on the bill and to tell them you won’t pay it because you are fighting the claim and see what they can do. Ask about an appeal. Have them at least put the bill on hold for a while to buy you time. Then document that conversation including the name (first and last) of the staff member you spoke to, time, date, and a
Call summary. Then contact your insurer, document everything and see about an appeal. I would also work other hospital angles if necessary, including the head of obstetrics, head of their women’s center, ombudsman, and patient care department. At a minimum complain vocally and loudly. Often if you make enough of a stink somehow the bill will end up getting dropped.

[Anonymous]

I would also echo the previous posters suggestion to contact your Hr and let them know about the issue. Often they can get in touch with the broker who sold the plan and they have levers to apply pressure to the insurer that help.

[Anonymous]

I ran into this problem when I delivered at sibley a year ago! BCBS ended up handling like 80 percent of the cost and I paid the difference. It took FOREVER to get sorted out.

Also, sibley had all of my correct contact information but the anes group had my old address from when I delivered my first. They sent several bills to that address, never called me, and then sent the bill that I never received to a bill collection agency. The whole process was bizarre and frustrating.

[Anonymous]

I delivered at Sibley 15 years ago (!!) with the same insurance and had the same problem. After a longish fight, we paid a fraction of the original bill, which at that time was $4,500. Push back, you won’t be the first!!

[Anonymous]

Oh the no surprises act sounds great. I think its terrible when you go to a hospital and some people are in net work and some are not. They should all be on the same page if they are working in the same hospital. Too hard for the patient to sort out, especially when in labor!!

[Anonymous]

Anonymous wrote:Hello, we have CareFirst insurance and recently delivered at Sibley. To our surprise, the anesthesiology group, Certified Anesthesia Services (which is apparently the only anesthesiology group at Sibley) does not take our insurance and sent a bill for $6000. Can anyone advise the best way to handle this? So many families have CareFirst in this area, I am sure I'm not the first one with this issue. Thank you!

Call the group and explain to them you do not have insurance coverage and you need the cash patient pricing. Use the healthcare bluebook site to inform them their price is unreasonable. If they hardball you tell them you will go to the media. Then you issue a formal complaint to the hospital that this contractor is price gouging.

[Anonymous]

Anonymous wrote:I ran into this problem when I delivered at sibley a year ago! BCBS ended up handling like 80 percent of the cost and I paid the difference. It took FOREVER to get sorted out.

Also, sibley had all of my correct contact information but the anes group had my old address from when I delivered my first. They sent several bills to that address, never called me, and then sent the bill that I never received to a bill collection agency. The whole process was bizarre and frustrating.

That would still have you out $1200. Pretty sure the fair price for an epidural is like $200-600.

[Anonymous]

Anonymous wrote:I delivered at Sibley 15 years ago (!!) with the same insurance and had the same problem. After a longish fight, we paid a fraction of the original bill, which at that time was $4,500. Push back, you won’t be the first!!

Sounds like they're doing it on purpose.

[Anonymous]

I had this same problem at Sibley earlier this year, it was infuriating. I called both my insurance (Cigna) and the anesthesia practice and told them that I refused to pay/this was incorrect since Cigna confirmed that Sibley was in network for my delivery with a flat copay. I honestly don't remember which one of them resolved it/how it was resolved, but I do remember that it was fully covered by insurance in the end, despite them initially saying it wouldn't be covered at all. I am sorry you are dealing with this too and hope you get a satisfactory resolution soon.

[Anonymous]

Anonymous wrote:

Anonymous wrote:That seems like a billing error. If the doctor and hospital both take your insurance carrier the anesthesia group should have too as well.

This. Also have carefirst, delivered at Sibley, and it was covered.

Same. Call them.