No Surprises

[myrdale]

I previously mentioned in another post about needing to get the rabies vaccine and briefly discussed the cost involved and that I was glad it was covered by insurance:

https://www.savingadvice.com/forums/...ally-expensive

Since then I received an additional explanation of benefits from my insurance with a $1,000 claim for ER charges which they denied. They said it was out of network. Shortly there after I received $1,000 bill from a medical group for the charges.

Prior to going to the ER, I called my insurance company and asked "Is Hospital Suchandsuch in my network" to which they said "yes". I asked "will this be covered" and they say "yes".

Even though the ER doctor saw me, and prescribed the vaccine, at some point in between a nurse practitioner touched my chart, and she was not in network. I don't recall actually seeing anyone other than the ER doctor.

I called the medical group which billed me, and they said to email a dispute, which I did. That's been a month and no word yet.

This morning on the way into work Clark Howard was discussing a new "No Surprises Act" which bans this exact practice of billing from an out of network provider working in an in network location.

I don't know if this is going to help my situation as the services were rendered in September, and this law passed in January. I will admit this is a nice piece of legislation. And I am not at all against paying for services rendered, but I walked into the ER that day with the certainty that I was seeing a doctor who was in my network. I also question why this nurse practitioner needed to be involved at all. Had she been in network and insurance paid, that would have been $1000 swept under the rug for services that were not provided.

[disneysteve]

The "No Surprises" act is a great idea. Sorry it wasn't yet in place when your incident happened. It's a very common problem. ERs are typically staffed by an outside contracted medical group not associated with the hospital. Anesthesiologists are the same way. You could have surgery at a network hospital by a network surgeon but get a big bill for your anesthesia because they aren't in your network.

As for the NP issue, it's not unusual for more than one provider to be involved with your case in the ER for various reasons.

Maybe you checked in at 6pm and a shift change happened at 7pm so provider A signed out your case to provider B.

Even more common is that provider A saw you and told the nurse to do test XYZ. A little while later, the nurse goes to do that test and finds that provider A didn't put in the order. Provider A is busy with another patient so nurse grabs provider B and asks them to enter the order so you can get the test done without a delay.