Hi. I had my PreOp meeting today with the Anesthesiology department. The nurse there told me that some hospitals contract out that function. Thus your surgeon and hosipital stay could be covered by your insurance but the doctor from this second vendor might not. She mentioned a couple hospitals in the area that have that kind of arrangement. So you might want to confirm that your hospital does not contract out that department. Who Knew!!!!

I called mine just to be sure and they said my insurance has a RAPS clause which means all Radiology, Anesthesiology and Pathology fees are pain in network as long as the hospital and surgeon is in network.

Where I live they contract out the darn ER doctors! Who would have thought that? So If you go to the ER for an emergency your hospital might be in network but it doesn't mean that doctor is. Crazy huh?

I once had an ER doc that was no in my network though the hospital was. I fought the coverage with the insurance because unless you ask the doctor how would you know? I won that one.

My insurance rep told me that even doctors that technically aren't with the insurance network usually have an "agreement" to accept what the insurance pays them. If they...or the facility...knows you need to use insurance for services and "sneaks" an out of network doctor in without your knowlege you might be able to insist that even doctors without formal agreements accept this payment if you seem serious about pursuing the whole informed consent thing with possible legal involvement.

the doctors only accept what insurance is willing to pay them if they are contracted with the insurance carrier. . . which could mean that they are out of your particular network but they contract with your insurance company and are part of another network... then they may accept what the insurance company pays.. less your deductible and coinsurance if your insurance company applies part of the bill toward those.. it can be tricky and insurance companies do whatever they can not to pay the bill so always check before hand just to be sure. I work in a physcian billing department so I see this all day everyday.. it is really confusing and sometimes insurance companies tell you one thing but it isn't necessarily the case for that physian or hospital so always make sure you double check and Always get the names of the reps that you speak to and when you speak to them.. and if possible get it in writing :rolleyes2:

Yeah I am still tissed at my anes. He told me I was gonna get to count backwards from 100 but the last thing I remember is them putting a blood pressure cuff on me lol.

Who is your INS carrier? I know most of the major ones (BCBS, CIGNA, etc) have a ARP clause (Anes, Rad, Path. the people that read your xrs and lab work) that even if they are OON, they will be covered INN. Which pretty much means if your INN is 85%, then you will owe 15% of whatever the ANES charges, as there would not be a "contractual discount" since they are just flexxing it in, unlike when you go to a Hosptial and they charge 20,000 but the INS pays them 5000 and you are responsible for the 85% of the 5000.

Edited August 2, 201016 yr by Knaroz
Clarification