Anyone have an issue with their epidural or other anasthesia not being covered by their insurance?

I got a bill for $8200! for my epidural.
Apparantly the anastheolgist who adminstered it does not take my insurance.
So GHI sent me a check for like $1300 ish and said since he is out of network that is all they will pay.

Now here is my issue- I was in an approved hospital, I was pre-authorized to be there obviously, my OB takes my insurance obviously. OB says do you want an epi and I say yes.

Am I now supposed to question the Dr who walks in to adminster that little bit o heaven as to whether or not he takes my insurance? And if I did and he said no I don't- should I have turned him away and gone natural? Come on now!
When I saw that man I wanted to kiss him because I knew the sweet relief he was about to bring me. The LAST thing on my mind was 'um excuse me but do you take GHI'?


I sent them the check from GHI for the $1300 but now I'm freakin out that I will be responsible for the rest- and that is an INSANE amount of money.

Anyone else deal with this?

Re: Anyone have an issue with their epidural or other anasthesia not being covered by their insurance?

i believe since it was a hospital provider that will have to accept what your insurance pays and that is it.

I bet if you call the anestesiologist's billing department they will explain it to you. Maybe you'll have a small copay up to some dedectible but it shouldn't be thousands of dollars.

Don't freak out yet...just make the call and they will explain.

Re: Anyone have an issue with their epidural or other anasthesia not being covered by their insurance?

yep and i have to pay....not 8200 though, more like 2K. Supposedly you need to call ahead and ask if the anasthesialogist takes our insurance.

Re: Anyone have an issue with their epidural or other anasthesia not being covered by their insurance?

Posted by XcalystaX

yep and i have to pay....not 8200 though, more like 2K. Supposedly you need to call ahead and ask if the anasthesialogist takes our insurance.

Re: Anyone have an issue with their epidural or other anasthesia not being covered by their insurance?

Did you sign some sort of financial waiver saying that you will be responsible for the costs that the insurance does not cover?

I remember I had to sign something like that when I delivered DS. DH worked at the hospital I delivered at so I was covered but I'm nervous this time around. We're at a new hospital and DH doesn't work at the same hospital. Everytime I get services, I sign this thing that says that if my insurance doesn't cover what they bill, I am responsible for the difference.

I think if a doctor is out of network, they are not obligated to take just what the insurance reimburses them. Many doctors that DH works with do this because insurance companies keep cutting reimbursements to the doctors. If the patient does not want to pay the difference, they go to another doctor who does accept their insurance.

Message edited 10/14/2010 12:33:05 PM.

Re: Anyone have an issue with their epidural or other anasthesia not being covered by their insurance?

same thing happened to me... i think the dr just recently stopped taking that insurence so i called and was able to get them to drop it.

Re: Anyone have an issue with their epidural or other anasthesia not being covered by their insurance?

I had this issue - not with the anesthesiologist, but with the neonatologist who was on call when DC were born.
I called the insurance company and explained the situation - I had a c-section, there was no choice, etc. They said "oh we understand that," and covered the services even though the dr. was out of network. It wasn't an issue at all.

Re: Anyone have an issue with their epidural or other anasthesia not being covered by their insurance?

I had a similar issue, except in the NICU as well. I didn't have a choice since there was only one neonatologist on call the day DS was born. We called the insurance company and the charges went away, except for my hospital co-pay (which we expected).

Message edited 10/14/2010 12:54:34 PM.

Re: Anyone have an issue with their epidural or other anasthesia not being covered by their insurance?

I did.

I doubt GHI will do anything, they didn't do anything for me.

If you call the anesthesiologist, they are likely to reduce the payment (didn't realize this until it was too late - currently in negotiation with them through collections though).

My bill wasn't nearly as high though

Re: Anyone have an issue with their epidural or other anasthesia not being covered by their insurance?

I had a similar issue with the ENT who saw my son in the NICU. I got an EOB from my insurance saying I was responsible for $20,000 in charges I havent gotten anything from the ENT so I will wait and see. If I end up getting a bill I will try to fight it/negotiate.

Re: Anyone have an issue with their epidural or other anasthesia not being covered by their insurance?

I had the same problem when I had my DD a couple of years back.

The hospital I delivered in, didn't have any anastheolgist in network...so no matter who I would have gotten it wouldn't have been competely covered.

What I did was call the billing dept of the anastheolgist. I talked it over with them after going back and forth with them a couple of times, they reduced the amount of the bill. So at least I didn't get charged what they normally charge the insurance companies.

Good Luck

Re: Anyone have an issue with their epidural or other anasthesia not being covered by their insurance?

this is pretty standard...
most anesthesiologists do not take insurance as in-network.. almost every single one is out of network.

I believe my total bill for c-section anesthesia was $3000 and Empire BCBS only wanted to pay $1500 in network..

The Anesthesiologists billing department worked w/ me to file an appeal. Basically they wrote it- and i signed it and sent it in.. and the decision was reversed and they got all the money they billed from BCBS after 9 months of back and forth!!!

Speak w/ the billing department and your insurance company- I am sure you can get it reduced and that the insurance company would pay more as well.

Re: Anyone have an issue with their epidural or other anasthesia not being covered by their insurance?

we went through this also, from what I have been told is that no anesthesiologists are in network, some insurances are good and go ahead and cover it, some stink and just don't. The anesthesiologist office even tried to send a legal letter to my insurance and they still wouldn't cover it.

Re: Anyone have an issue with their epidural or other anasthesia not being covered by their insurance?

What I want to know is how an eipdural- which is just a LOCAL anasethic is $8200???
I had surgery where I was PUT OUT and intubated and unconscious and that was only $1800.
How is an epi $8200?

That is highway robbery and should be illegal IMO. So if he wanted to charge me $100 K could he have? This is insanity.

This is just one of the MANY issues with healthcare in this country... these Dr's who bill exorbitant amounts for services.

Message edited 10/14/2010 3:42:20 PM.

Re: Anyone have an issue with their epidural or other anasthesia not being covered by their insurance?

Re: Anyone have an issue with their epidural or other anasthesia not being covered by their insurance?

Posted by NervousNell

Posted by XcalystaX

yep and i have to pay....not 8200 though, more like 2K. Supposedly you need to call ahead and ask if the anasthesialogist takes our insurance.

And then if they don't? You have to use another hospital? Bring your own anasthesialogist in?
This is ridiculous!

Message edited 10/14/2010 5:11:56 PM.