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[quote=Anonymous][quote=Anonymous][quote=Anonymous]^thought balance billing was when you used an in network facility that employed an out of network provider.  I.e. surgeon and surgery center are in network but anesthesiologist is not.  This is a real PITA issue by the way, [b]I have tried to verify whether certain support functions were in network and they have no way of knowing so no way for a patient to have a meaningful choice[/b].[/quote]

If anesthesiologist at the surgery center where you are covered is not in network then they will work this out with you and have you give them whatever insurance pays (they usually give you a check for a portion of the bill if out of network). I've done this more than once.  It's disclosed beforehand, insurance billed for out of network, insurance sends a claim to you with crazy charges and a check for whatever they cover. You are only responsible for the portion insurance paid for if out of network professionals have a contract with the in-network facility and your surgeon.

Of course, this is something to discuss beforehand and if they aren't upfront about this, you do have to be vigilant and inquire if every medical professional/service you need for your procedure or treatment are in network and how out of network charges will work.   I disagree that it's impossible to find out, there are more obligations and regulations now on price transparency than before. They do know who is in network and who is not.  And if they do a last minute substitution to stick you with someone out of network you are under no obligation to pay them more than your insurance would.  If they bill you then dispute and they adjust it.

It happened to me many years ago during hospital delivery of my first child when healthcare companies operating there had undergone restructuring and I ended up with huge out of network charges.  I disputed this, made multiple calls with my insurance and old/new provider companies and sorted this out.  It dragged on for months and I had to made repeated calls, but it's supposed to be better now.  I paid nothing extra.  [/quote]

PP here and I don't know what to say, I called the facility and asked if the anesthesiologist was in network for both DW's delivery and for my vasectomy.  In both cases they had me speak to the anesthesiology department or practice or whatever.  What that place told me was that they contract with a bunch of different people and all of them have different insurances that they accept and they had no way of knowing who was on the schedule for the day I was going to be there or who would be assigned to me that day.

I have FEHB BCBS and it turns out they were in-network on both occasions but I did what I thought was my best to find out, I'm not sure what else I could have done but I was lucky I didn't have to fight an out of network charge.  This was five years ago, maybe things are different today.[/quote]

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