Some ER docs in Alex/Springfield (INOVA) not in network with BCBS

[Anonymous]

I recently went to the ER at the INOVA Healthplex in Springfield and was seen by a doctor who works for Alexandria Springfield Emergency Physicians. Evidently this is a company that contracts with INOVA, so the doctor is not actually employed by INOVA. And it turns out this company is not a participating provider with federal BCBS. I have the Basic plan, so now I owe several hundred dollars out of pocket for my ER visit. This comes as quite a shock compared to the cost of other ER visits by members of my family over the last few years.

I know that going to an in network hospital does not guarantee all of the services/providers will be in network. But I was really surprised (and disappointed!) to learn that a portion of my visit to a facility that is part of one of the largest health care providers in the area (INOVA) was not covered by one of the largest health insurance companies in the area (federal BCBS).

Has this happened to anyone else? The company says they've gotten lots of calls from people like me with BCBS. Personally, I will not be going back to that ER again. They say they are working on becoming in network with BCBS, but who knows when that will happen. According to their website, these doctors also contract at INOVA Alexandria. So I would just warn against visiting these two ERs if you have federal BCBS!

[Anonymous]

File an appeal. If it's an emergency situation in which you don't have control over which doctor sees you, the doctor should not balance bill you. I had a similar issue with CareFirst. Filed an appeal and they settled it with the surgeon

[Anonymous]

Anonymous wrote:File an appeal. If it's an emergency situation in which you don't have control over which doctor sees you, the doctor should not balance bill you. I had a similar issue with CareFirst. Filed an appeal and they settled it with the surgeon

Thanks for the tip! I didn't realize I could have some recourse in this situation. You filed an appeal with the insurance company? Or the provider? And what does filing an appeal involve? Writing a letter?

[Anonymous]

Call Blue Cross. They will take care of it

[Anonymous]

I don't have any suggestions OP, but thanks for the heads up. We live close by and have typically used the Healthplex as our ER when needed.

[Anonymous]

I had an insurance company pull the same kind of BS on me when living in NYC, I had emergency surgery after being admitted in the ER and they said the anesthesiologist was not in network. PP is right, you need to fight back with an appeal. Just know you may need to do several appeals - I actually fought mine for about six months before I won. I honestly think they pull this stuff just to see what they can get away with. SO many people would just write the check and be done with it.

[Anonymous]

Obamacare -- and so it begins.

[Anonymous]

Anonymous wrote:Obamacare -- and so it begins.

Sorry, they've been pulling this BS for years. Thanks for playing the troll game, though!

[Anonymous]

Anonymous wrote:

Anonymous wrote:File an appeal. If it's an emergency situation in which you don't have control over which doctor sees you, the doctor should not balance bill you. I had a similar issue with CareFirst. Filed an appeal and they settled it with the surgeon

Thanks for the tip! I didn't realize I could have some recourse in this situation. You filed an appeal with the insurance company? Or the provider? And what does filing an appeal involve? Writing a letter?

I started with my company's benefits coordinator (private company). Since it was out of network, CareFirst sent me a check for a portion of the bill. Once I sent that money to the surgeon I got a copy of the balance and typed up a letter to CareFirst explaining that I was an in-network hospital but did not have an option of who my surgeon was (middle of the night emergency appendectomy). They settled up with the surgeon. I have no idea if that means they paid the surgeon the balance or told them to piss off. It took a long time and the surgeon was threatening to take me to collections, but it worked out.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Obamacare -- and so it begins.

Sorry, they've been pulling this BS for years. Thanks for playing the troll game, though!

Indeed. My insurance company tried to pull this with the anesthesiologist at Holy Cross when my daughter was born in 2004.

[Anonymous]

So if I do have Anthem BC/BS, does anyone know which ERs are safe to visit? I live closest to INOVA Mt. Vernon.

[Anonymous]

Anonymous wrote:So if I do have Anthem BC/BS, does anyone know which ERs are safe to visit? I live closest to INOVA Mt. Vernon.

Check your plan's guide for covered facilities. All the ERs seem to be pulling this crap now, so all you can do is go and call your insurer of you get a bill for, the ER that is not in line with your policy terms.

[Anonymous]

Had the same issue with and ER visit to VHC in Arlington. I filed an appeal with BCBS and they settled it. The hospital also billed me incorrectly so BCBS was going to bill me for the entire cost of an emergency procedure. ALWAYS call!!

[Anonymous]

Ugh. Went to VHC ER and just found out doctor is out of network. I can't stop worrying about the bill that I am going to get from this doctor. I wish I stayed with my fed HMO.

[Anonymous]

I would call and dispute it. I think surprise billing like this should be against the law. I've gone to doctors twice who were in-network but then used out-of network labs for blood work and I was left on the hook for the bill.

Make sure you file a dispute with your state's consumer protection agency or the Attorney general. I did this with a bill I got from GW hospital also and they reduced it by a lot. I also filed a complaint with the better business bureau.