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NervousNell
Just another chapter in life..
Member since 11/09 54921 total posts
Name:
..being a mommy and being a wife!
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Has this happened to anyone? (Hospital/Insurance issue)
I have 2 different insurance carriers- Emprie Blue Cross for Hosptialization and GHI for Dr's appts etc.
Last week I had to have surgery- I was admitted through the ER and assigned a surgeon who did my procedure the next morning.
When I registered at the ER I gave them my Empire Blue Cross card- since that is for the hospital. They never asked me for GHI info- I thought all was well.
I just got a statement from GHI saying the surgeon who did my operation was NOT in their network and as such they are only paying $2,000 of his $12,000 fee for surgery, etc.
I called them and they told me that after I was admitted to the hospital all services performed by any Dr was to bill though GHI- not Empire. Empire only covers the ER, the room fees, meds, xrays, etc.
My issue is- NOBODY ever told me this at the hospital. THEY assigned me this surgeon-he was the only surgeon on call that night. I did not ask for this Dr. Never once did they ask me for another form of insurance to cover him...How was I to know I had to make sure he took GHI? I was in a lot of pain, scared, etc...that was the last thing on my mind.
Has anyone else ever dealt with this?
I tried calling the Dr's office- but they are closed today.
I am petrified I will be responsible for a huge bill that we can't afford...
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Posted 8/11/10 2:36 PM  |
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mathteach
Roll Tide!
Member since 8/08 3169 total posts
Name:
Christine
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Re: Has this happened to anyone? (Hospital/Insurance issue)
This happens to me ALLL Of the time. Are you a NYC employee?
Just submit the EOB and the check that GHI sent to cover the surgeon when you get the bill. 99.9% of the time, they accept it and everyone moves on with their lives.
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| Posted 8/11/10 2:39 PM |
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NervousNell
Just another chapter in life..
Member since 11/09 54921 total posts
Name:
..being a mommy and being a wife!
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Re: Has this happened to anyone? (Hospital/Insurance issue)
Posted by mathteach
This happens to me ALLL Of the time. Are you a NYC employee?
Just submit the EOB and the check that GHI sent to cover the surgeon when you get the bill. 99.9% of the time, they accept it and everyone moves on with their lives.
Yes my DH is a NYC employee.
Oh this is SOOO good to hear... I mean GHI paid like $2000 out of a HUGE bill...so I was freaking out thinking the surgeon would bill me the difference...which we could never afford.
I am glad to hear this is common.
It's crazy that it works that way!
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| Posted 8/11/10 2:47 PM |
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tara73
carseat nerd
Member since 11/09 3669 total posts
Name:
Buttercup
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Re: Has this happened to anyone? (Hospital/Insurance issue)
Just be forewarned that the surgeon doesn't HAVE to accept their rate and CAN balance bill you since they don't have a contract to accept your insurance's rates.
GHI should pay if you fight with them though. You didn't get a choice of surgeon, you were most likely assigned whoever was on call, so long as it was at a contracted hospital and was an emergency they should cover his rate. Usually a call to the insurance will get them to pony up the restn.
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| Posted 8/11/10 2:56 PM |
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Faithx2
All good things in 2016!!
Member since 8/05 20181 total posts
Name:
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Re: Has this happened to anyone? (Hospital/Insurance issue)
Posted by tarabelle99
GHI should pay if you fight with them though. You didn't get a choice of surgeon, you were most likely assigned whoever was on call, so long as it was at a contracted hospital and was an emergency they should cover his rate. Usually a call to the insurance will get them to pony up the restn.
Absolutely. Call your insurance and tell them this. There should be a prompt to dispute a claim etc on the recording so you know what dept to talk to 
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| Posted 8/11/10 3:05 PM |
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Shorty
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Member since 5/05 30390 total posts
Name:
really
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Re: Has this happened to anyone? (Hospital/Insurance issue)
i believe there's special consideration when you're admitted through emergency, too....
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| Posted 8/11/10 3:08 PM |
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NervousNell
Just another chapter in life..
Member since 11/09 54921 total posts
Name:
..being a mommy and being a wife!
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Re: Has this happened to anyone? (Hospital/Insurance issue)
Posted by Shorty
i believe there's special consideration when you're admitted through emergency, too....
THat is what I was thinking- it's not like this was elective or planned surgery and I chose a Dr who didn't take GHI.
I was assigned the surgeon on call- it was considered an emergency.
Thanks guys- I feel better.
I will fight GHI if I have to...hopefully it won't go that far...
Ugh- Insurance! 
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| Posted 8/11/10 3:19 PM |
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