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  1. #1
    Join Date
    May 2009
    Posts
    1

    Default Billed for Surgery Without Prenotification

    My question involves collection proceedings in the State of: PA

    I went to a doctor from my health insurance network his services are covered and paid by the insurance. He directed me to a nearby surgery center where he performed the surgery.

    I now get the insurance summary and the surgery center is not part of the insurance network. The insurance paid about 1/3 of the billed services and now I'm liable for 2/3 of a bill in the thousands.

    I was never notified by my doctor or the surgery center they they were not in network. Nor was i notified of the total amount of charges.

    When you buy a car they have to disclose all the charges and fees, when you buy a house they have to disclose cost. Are there any medical disclosure laws in Pennsylvania?

    I did sign several forms when getting pre-op testing one was saying i am responsible for charges not paid by insurance. I was thinking they are talking about copays and deductibles not 2/3 of the bill. Never mentioned they were not in network and insurance would only pay 1/3 of billed charges. Plus I never received a copy of the forms signed.

    Help!!!

  2. #2
    Join Date
    Jan 2008
    Location
    Toledo, OH
    Posts
    16,307

    Default Re: Billed for Surgery Without Prenotification

    I was never notified by my doctor or the surgery center they they were not in network.
    It's not your doctor's responsibility to know if a given office, hospital or surgery center is in your network - it's yours, and you are responsible for double checking with your insurer before receiving services.

    Most insurers these days even have a facility online which allows you to search the name of the physician, hospital or center to determine if it is in or out of network.
    I did sign several forms when getting pre-op testing one was saying i am responsible for charges not paid by insurance. I was thinking they are talking about copays and deductibles not 2/3 of the bill.
    Sounds to me like the form explicitly stated all charges not covered by insurance. You are responsible for them.

    Plus I never received a copy of the forms signed.
    One usually doesn't. You may certainly request copies from your doctor's office, but handing them over to the patient at the time of service isn't usually SOP.

  3. #3

    Default Re: Billed for Surgery Without Prenotification

    You might appeal the claim with the insurance company. If it is the only center the surgeon works with or the only facility in the area, you might have some luck. I had a situation once where I ended up in an out of network facility, but because it was the only option in the area, the insurance did cover it on appeal. In my case in my state, they legally had to make allowances for what was actually available.

    I had a really good insurance agent at the time and she worked it through the insurance company for me.

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