Health/Healthcare Lawyer
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Anonymous
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We got caught in the scam that Pediatrix is running at Inova Alexandria, which is supposed to be a Cigna facility but allows non-Cigna physicians to attend to patients (note: this is probably not specific to Cigna). Cigna tells us we've exceeded the threshold to appeal these claims. We are looking at some hefty bills. I'd like to get a lawyer involved -- any recommendations?
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Anonymous
| Did they not tell you at delivery they were out of network. They gave me the paperwork at the hospital to fill out so they could appeal the charges directly with the insurance provider (UHC). I ended up needing to follow up on one bill a few weeks after delivery but in the end everything was paid for with little issue. This group is al almost all the hospitals in the area and they are out of network for everyone. |
Anonymous
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If this is an employer sponsored plan ask your HR department to involve their broker. Our broker has gotten several claims paid to this practice. We have Cigna too.
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Anonymous
| a lawyer will do nothing but cost you money. your best bet is to negotiate the rate down to in network. do that yourself or ask your employer that purchases the insurance to help. this issue is SUPER common, and it's not a scam, it's how things work at many facilities. |
Anonymous
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Sounds like you didn't appeal within the time frame? If so, there is fuck all you can do besides beg.
Anyway, I have Cigna and pediatrix was billed in network for me at Inova fairfax. |
Anonymous
I understand the issue is common and recognize it's not a scam in the purest sense. But I'd say there's an ethical bend to this that's questionable. The reason I'm considering a lawyer is that the insurance company is denying my appeal on the grounds it's been more than 180 days to file. And to put it in perspective, if my insurance company is expecting me to pay $5000 out of pocket and I can get a lawyer to resolve this for $1000, I will come out on the other side better off... |
Anonymous
Correct. I may engage the broker at the corporate level. There may be some leverage... |
Anonymous
I'm the one who recommended the broker. I didn't read carefully enough because I missed that you are out inside of the appeals window. You can try and see if the broker can help, but missing the claims deadline is usually a no go. Were you trying to negotiate on your own and that's why you missed the deadline? Or did the bill just come in? |
Anonymous
| Was it an emergency situation, or did you not request your pediatrician for routine care at the hospital? |
Anonymous
I will admit that my wife and I are wholly ignorant as to the insurance intricacies of the healthcare system. We tend to open Explanation of Benefits (EOB) statements and discard them, waiting for a bill from the provider before taking action. However, Cigna uses the EOBs as the starting point for the claims deadline, so we obviously learned our lesson on this. My interest in considering counsel is that the EOB associated with this particular case of contention has a note to the provider -- not the consumer -- yet Cigna believes it was the consumer's responsibility to make the appeal. |
Anonymous
Our pediatricians -- through PAA in Alexandria -- tended to our newborn. However, it appears a non-Cigna clinician administered a hearing test. |
Anonymous
| How much are the bills? Honestly I think you don't have anything to stand on. Your best bet is to negotiate down the rates to in network level. |
Anonymous
We appealed this and had it covered as in-network in 2013. There were no Cigna providers at Alexandria hospital. |