Reply to insurance, billing and Children's

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[quote=Anonymous]Thanks all.  They're definitely in network - that's part of what I don't understand.  If I go to an in network doctor, for a covered service, and see only that in network doctor, how could I possibly end up with a charge for something that isn't covered?  I thought too they were contractually obligated as in network providers to follow whatever insurance allows as far as billing - it's not like they can say, well yes, insurance only allows $90 for an office visit, but we're making you pay the extra $100 we'd like to charge, so how can they say, well, yes, insurance doesn't cover facility fee, so we're charging you the extra $150?

It does suck because there really are almost no non-hospital based specialists for some of these things (there may actually be none).  And when we go for one appointment (say genetics) we don't get a facility fee (but did get some parent education fee that wasn't covered or disclosed ahead of time) and when we go for ophthalmology - same building, different floor - we DO get a facility/clinic/whatever fee.  How does that make ANY sense!?  And what I'm getting from insurance is if Children's would just bill using code XYZ, which is the facility fee code, rather than ABC, which is the clinic code, then it'd be covered, at least partially under outpatient benefits.  Nevermind that nowhere in our plan documents that I was provided with does it say these "clinic" fees aren't covered (nor can anyone explain what a clinic fee is...)   Sad to hear it's neither unique to us or BCBS and I guess we just have to refuse to be referred to anyone at Children's.  [/quote]

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