Okay, I was self pay but my doctor checked me for a hernia and I had one. So since I had one the surgery was almost half the price because they were going to bill the insurance for the anesthesia, hernia repair, and I am paying for the band. Well surgery went great last week I received a bill for 48l. My insurance said not paying because the doctor was not in my network. First I'm concerned because without the hernia my surgery was gonna be 10k with the hernia it is 5,500. Where in the heck did 47k come from and who do they expect to pay it?????!

It sounds like you!

I think they expect you to pay it................Did you talk to your surgeon (is this bill for 48k from your surgeon?)

First ask for an accounting of charges so you can see what they are demanding payent for. are the hospital and dr fees all together? Did you think to ask or find out if the dr was in the network before you had your surgery,... If not that may be a costly mistake. The hospitals charge insurance companies different than self pay so what you might be seeing is the insurance bill.

No doubt you have in writing what your share of the costs are so start with the dr and thn the hospital and go from there. Good luck

I have the same thing.. although it says it is not a bill.. my surgery was suppose to be covered 90% and well, It says.. your responsibilty is 98k.? lol.. ya I totally L O L.'d. Has to be some mistake.. thats nuts. ! they gave me a print out before surgery saying my part would be 175.00 only.

Yea the bill came from my insurance company it was my EOB. So I haven't been contacted my the hospital. But no I did not check to see out the out of area I did receive an approval from the insurance company showing they had approved for the dr to do my EGD. So I assumed they had prior authorization before they preformed the surgery. Yes I have what I was supposed to pay already paid it with my care credit card so my surgery has been paid for already.

I was only 3 days out of surgery when I got a billing from the surgical center for 48k, of which they claimed 9k was my responsibility because my insurance wasn't covering it. First of all, there was no way the insurance had even SEEN that claim in 3 days, and second, when I went through their numbers, that 9k was just a number tossed in and didn't correspond to anything! I talked to my surgeon and he said he had no idea why they do that, but they try to intimidate patients into paying what they know is the amount above what the insurance agreements are! Douchebaggery, IMO.

At any rate, my insurance company has been waiting for information from the surgical center in order to process the claim for almost 3 months now, so nothing has been paid yet. The whole thing is hugely stressful, but I'm just going to let my insurance company duke it out with them.

Since what you got was an EOB, I would call your insurance person and see what you can work out as far as an appeal, then contact the hospital and see what they will do for you as a self-pay.

Good luck!

Another thought, if your insurance is through your company: a lot of companies have insurance brokers who sell the insurance to the company. they also can fight for you. If the company is not too large you may be able to contact that person for assistance. Larger companies may not even know if there is one.

Throwing on a 9k charge to get more money out of the claim is fraud and a breach of contract between the insurance company and the drs/ hospital. When you have insurance, the hospital/drs agree to the contract of the insurance they accept. Going around the contract to get more money is not ok. I'd fax that puppy to the insurance company and bring it to their attention. Also the BBB can help.

Yep, I've already begun the process...in the meantime, the insurance company is still waiting for detailed information from the center before processing the claim. I have returned the latest request for payment with a request that they pay attention to the insurance company if they intend to make a dime on any of the procedure at all.

BBB is toothless; providers aren't too worried about it. Try your state's attorney general or department of insurance. Good luck!

I agree, but I always include BBB in any complaint, just so there is something on record if anyone else is looking at a company through them. The State Attorney General has been pretty good any time I've had a problem with a company anywhere in the US. Depending on where this goes, I will probably involve the State Insurance Commissioner as well.

I received my bill for $41K two weeks ago. I'm a cash patient and signed all kinds of documents stating the only thing i would be required to pay beside the original $10K was if i had to have a hernia repair. Which they repaired. I called my surgeon immediately about the bill and they said they would take care of it. I think its a lack of communication between the hospital and surgeon. I am staying on top of them about it because i don't want that crap on my credit.

Crazy how they only charged me $10K and then the bill comes and says $41K.

I received my bill for 41K two weeks ago. I'm a cash patient and signed all kinds of documents stating the only thing i would be required to pay beside the original 10K was if i had to have a hernia repair. Which they repaired. I called my surgeon immediately about the bill and they said they would take care of it. I think its a lack of communication between the hospital and surgeon. I am staying on top of them about it because i don't want that crap on my credit.

Crazy how they only charged me 10K and then the bill comes and says 41K.

I guess I will wait till a actual bill come because what I received was my EOB from my insurance company letting me know how much I am responsible for. Glad to know I'm not alone in this being a cash pay patient

I received my bill for 41K two weeks ago. I'm a cash patient and signed all kinds of documents stating the only thing i would be required to pay beside the original 10K was if i had to have a hernia repair. Which they repaired. I called my surgeon immediately about the bill and they said they would take care of it. I think its a lack of communication between the hospital and surgeon. I am staying on top of them about it because i don't want that crap on my credit.

Crazy how they only charged me 10K and then the bill comes and says 41K.

Finally got a new bill and everything was corrected. I don't owe anything. Glad they resolved that. Because it was going to be very hard trying to get that kind of money out of me.

It sounds like you!

Lol

I got an Eob from my insurance for 9,000.00 because the surgery was not approved. Called them and told them I have my copy of the approval letter and they better fix it.